=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730173618
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA M OLESKI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2005
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 SUNSET AVE
-----------------------------------------------------
City | WESTHAMPTON BEACH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11978-2331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-953-4500
-----------------------------------------------------
Fax | 631-953-4570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 HICKSVILLE RD STE 205
-----------------------------------------------------
City | BETHPAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11714-3472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD 417233
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------