Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 233359 | NY |
NPI | 1053412874 |
---|---|
Provider Name | Dr. Olga Panchenko |
First Address | Brooklyn, NY 11235-8439 |
Second Address | Brooklyn, NY 11235-8439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02622640 | (05) | NY |
I19882 | (02) | NY |