Provider Demographics
NPI:1609415645
Name:KIRILUK, OLGA (FNP)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KIRILUK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 1ST AVE APT 2201
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3328
Mailing Address - Country:US
Mailing Address - Phone:929-600-1917
Mailing Address - Fax:
Practice Address - Street 1:1060 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1715
Practice Address - Country:US
Practice Address - Phone:646-672-6893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR20600600163W00000X
NY742389163WP0808X
NJ26NJ01259900363LF0000X
NYF347889-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health