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NPI Code Detail

MEDICARE: OLGA KYSELOVA MSED

MEDICARE: OLGA KYSELOVA MSED
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
1103K00000XBehavior Analyst1195032NY
2174400000XSpecialist1195032NY

General Provider Information

NPI Number : 1588941413
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLGA KYSELOVA MSED
Provider Business Mailing Address
First Line : 1616 66TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11204-4212
Country : US
Telephone Number : 347-879-4249
Fax Number :
Provider Business Practice Location Address
First Line : 1201 66TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-5914
Country : US
Telephone Number : 347-879-4249
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2011
Last Update Date : 06/13/2012

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Directions to “ OLGA KYSELOVA MSED” Practice Location

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