Provider Demographics
NPI:1861580201
Name:OLSHANETSKIY, OLEG (DO)
Entity type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:OLSHANETSKIY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LA GUARDIA AIRPORT
Mailing Address - Street 2:CENTRAL TERMINAL BUILDING, ROOM 3771, 3RD FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11371
Mailing Address - Country:US
Mailing Address - Phone:718-424-8663
Mailing Address - Fax:718-424-8664
Practice Address - Street 1:AIRPORT MEDICAL OFFICES AT JFK
Practice Address - Street 2:23059 ROCKAWAY BLVD SUITE 225
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11413
Practice Address - Country:US
Practice Address - Phone:718-244-1644
Practice Address - Fax:718-244-1622
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215014-2207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HO3523Medicare UPIN
NY12U061Medicare ID - Type Unspecified