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General NPI Number Information
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NPI Number | 1740295278
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Entity Type | Individual
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Provider Name | SERGEY KALITENKO
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 8295 N MILITARY TRL STE G
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City | WEST PALM BEACH
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State | FL
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Zip | 33410-6312
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Country | US
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Telephone | 718-382-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 10710 SHORE FRONT PKWY APT. 10F
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2637
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Country | US
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Telephone | 718-382-9200
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 211326-1
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License Number State | NY
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