Provider Demographics
NPI:1124191325
Name:OLEG KATCHER MDPC
Entity Type:Organization
Organization Name:OLEG KATCHER MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:KATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-758-4379
Mailing Address - Street 1:1765 EAST 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2201
Mailing Address - Country:US
Mailing Address - Phone:718-758-4379
Mailing Address - Fax:
Practice Address - Street 1:1765 EAST 19TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2201
Practice Address - Country:US
Practice Address - Phone:718-758-4379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211769207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02461714Medicaid
NJI00476Medicare UPIN
NYWZT3D1Medicare PIN