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General NPI Number Information
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NPI Number | 1700845187
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Entity Type | Individual
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Provider Name | GENNADY UKRAINSKY M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 10812 72ND AVE 3RD FLOOR
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City | FOREST HILLS
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State | NY
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Zip | 11375-7079
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Country | US
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Telephone | 718-544-9300
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Fax | 718-544-9301
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Provider Business Mailing Address
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Address Line | PO BOX 2625
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City | NEW YORK
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State | NY
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Zip | 10009-8925
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Country | US
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Telephone | 914-471-3422
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Fax | 646-928-2360
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 234912
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License Number State | NY
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