Provider Demographics
NPI:1598902843
Name:ROYTMAN, OLEG (RPH)
Entity Type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:ROYTMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3436
Mailing Address - Country:US
Mailing Address - Phone:718-226-1914
Mailing Address - Fax:718-226-1688
Practice Address - Street 1:475 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3436
Practice Address - Country:US
Practice Address - Phone:718-226-1914
Practice Address - Fax:718-226-1688
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2023-06-06
Deactivation Date:2023-05-18
Deactivation Code:
Reactivation Date:2023-06-06
Provider Licenses
StateLicense IDTaxonomies
NY051289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist