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General NPI Number Information
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NPI Number | 1508907510
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Entity Type | Organization
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Legal Business Name | OLEG KOTELSKIY D.O., P.C.
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Dates
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Enumeration Date | 02/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3816 NOSTRAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11235-2013
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Country | US
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Telephone | 347-713-6871
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Fax | 347-713-6946
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Provider Business Mailing Address
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Address Line | 3816 NOSTRAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11235-2013
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Country | US
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Telephone | 347-713-6871
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Fax | 347-713-6946
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Authorized Official
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Title or Position | PHYSICIAN
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Name | OLEG KOTELSKIY
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Credential | D.O.
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Telephone | 347-713-6871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2050591
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License Number State | NY
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