MEDICARE: OLENA DOTSENKO MEDICAL P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	246407	NY

General Provider Information

NPI Number	:	1538548086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLENA DOTSENKO MEDICAL P.C.

Provider Business Mailing Address
First Line	:	361 91ST ST
Second Line	:	APT. 2
City	:	BROOKLYN
State	:	NY
Zip	:	11209-5807
Country	:	US
Telephone Number	:	917-327-0490
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 91ST ST
Second Line	:	APT. 2
City	:	BROOKLYN
State	:	NY
Zip	:	11209-5807
Country	:	US
Telephone Number	:	917-327-0490
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. OLENA DOTSENKO
Credential	:	M.D.
Telephone Number	:	917-327-0490

Provider Enumeration Date	:	05/29/2015
Last Update Date	:	05/29/2015

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