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General NPI Number Information
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NPI Number | 1831692136
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Entity Type | Individual
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Provider Name | OLGA S PANKIV
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Gender | Female
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 545 5TH AVENUE SUITE 817 545 5TH AVENUE SUITE 817
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City | NEW YORK
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State | NY
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Zip | 10017
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Country | US
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Telephone | 718-913-6861
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Fax |
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Provider Business Mailing Address
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Address Line | 37 E 28TH ST #700 EUREKA BODY CARE AND SPA
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City | NEW YORK
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State | NY
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Zip | 10016
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Country | US
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Telephone | 212-858-0706
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F308322
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License Number State | NY
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