Provider Demographics
NPI:1184815946
Name:EPELBAUM, OLGA A (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:A
Last Name:EPELBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EPELBAUM
Other - Middle Name:A
Other - Last Name:OLGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6205 84TH ST
Mailing Address - Street 2:APT B4
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2017
Mailing Address - Country:US
Mailing Address - Phone:718-651-3467
Mailing Address - Fax:
Practice Address - Street 1:6205 84TH ST
Practice Address - Street 2:APT B4
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2017
Practice Address - Country:US
Practice Address - Phone:718-651-3467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242936207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400056199Medicare PIN