Provider Demographics
NPI:1326228669
Name:DOTSENKO, OLENA (MD)
Entity Type:Individual
Prefix:
First Name:OLENA
Middle Name:
Last Name:DOTSENKO
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 1:361 91ST ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5807
Mailing Address - Country:US
Mailing Address - Phone:917-327-0490
Mailing Address - Fax:
Practice Address - Street 1:361 91ST ST
Practice Address - Street 2:APT. 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5807
Practice Address - Country:US
Practice Address - Phone:917-327-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246407207R00000X
NE27910207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease