Provider Demographics
NPI:1760667836
Name:GORENBURG, OLEG (DO)
Entity type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:GORENBURG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:54 FORT HILL CIR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1717
Mailing Address - Country:US
Mailing Address - Phone:646-915-7885
Mailing Address - Fax:718-668-0384
Practice Address - Street 1:176 BRIGHTON 11TH ST FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5327
Practice Address - Country:US
Practice Address - Phone:718-484-8410
Practice Address - Fax:718-484-8413
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY234253-02207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty