Provider Demographics
NPI:1063458057
Name:OSLON, LYUDMILA (MD)
Entity Type:Individual
Prefix:DR
First Name:LYUDMILA
Middle Name:
Last Name:OSLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15028 UNION TPKE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3928
Mailing Address - Country:US
Mailing Address - Phone:718-969-4357
Mailing Address - Fax:718-969-4345
Practice Address - Street 1:15028 UNION TPKE
Practice Address - Street 2:SUITE 500
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3928
Practice Address - Country:US
Practice Address - Phone:718-969-4357
Practice Address - Fax:718-969-4345
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207223208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01793186Medicaid
NYG58686Medicare UPIN
NY01793186Medicaid