Provider Demographics
NPI:1184662181
Name:LUSHPENKO, OLEG (MD, DO)
Entity Type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:LUSHPENKO
Suffix:
Gender:M
Credentials:MD, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-6308
Mailing Address - Country:US
Mailing Address - Phone:718-498-4420
Mailing Address - Fax:
Practice Address - Street 1:580 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-6308
Practice Address - Country:US
Practice Address - Phone:718-498-4420
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ02388829Medicaid
NJ02388829Medicaid
NY5200D1Medicare ID - Type UnspecifiedEMPIRE MEDICARE