Provider Demographics
NPI:1093891079
Name:OLENKO, EVGENY (MD)
Entity Type:Individual
Prefix:
First Name:EVGENY
Middle Name:
Last Name:OLENKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105-37 64 AVENUE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1645
Mailing Address - Country:US
Mailing Address - Phone:718-459-0111
Mailing Address - Fax:718-896-1596
Practice Address - Street 1:10537 64TH AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1645
Practice Address - Country:US
Practice Address - Phone:718-459-0111
Practice Address - Fax:718-896-1596
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145218207ZP0101X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00736250Medicaid
NY39788Medicare PIN
NY00736250Medicaid