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NPI Code Detail

MEDICARE: OLSHANETSKIY AND GOUTOS MEDICINE, PC

MEDICARE: OLSHANETSKIY AND GOUTOS MEDICINE, PC
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
1207RP1001XPulmonary Disease Physician
2207RS0012XSleep Medicine (Internal Medicine) Physician

General Provider Information

NPI Number : 1871788802
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLSHANETSKIY AND GOUTOS MEDICINE, PC
Provider Business Mailing Address
First Line : PO BOX 14008
Second Line :
City : HAUPPAUGE
State : NY
Zip : 11788-0774
Country : US
Telephone Number : 631-231-0300
Fax Number : 631-231-3331
Provider Business Practice Location Address
First Line : 326 7TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11215-3311
Country : US
Telephone Number : 877-275-3370
Fax Number : 631-231-3331
Authorized Official
Title or Position : OWNER
Name : OLEG OLSHANETSKIY
Credential : D.O.
Telephone Number : 718-244-1644
Provider Enumeration Date : 09/12/2007
Last Update Date : 08/05/2008

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