MEDICARE: MR. OLEG GREGORY GONIK

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	156FX1800X	Optician	006985	NY

General Provider Information

NPI Number	:	1659556116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OLEG GREGORY GONIK

Provider Business Mailing Address
First Line	:	2011 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3801
Country	:	US
Telephone Number	:	718-469-3311
Fax Number	:	718-928-7262

Provider Business Practice Location Address
First Line	:	2011 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3801
Country	:	US
Telephone Number	:	718-469-3311
Fax Number	:	718-928-7262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	06/05/2023

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