Provider Demographics
NPI:1871788802
Name:OLSHANETSKIY AND GOUTOS MEDICINE, PC
Entity type:Organization
Organization Name:OLSHANETSKIY AND GOUTOS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSHANETSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-244-1644
Mailing Address - Street 1:PO BOX 14008
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-0774
Mailing Address - Country:US
Mailing Address - Phone:631-231-0300
Mailing Address - Fax:631-231-3331
Practice Address - Street 1:326 7TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3311
Practice Address - Country:US
Practice Address - Phone:877-275-3370
Practice Address - Fax:631-231-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY09560Medicare PIN
NYWYWTX1Medicare PIN