Provider Demographics
NPI:1659346815
Name:VENIKOVA, GALINA (MD)
Entity Type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:VENIKOVA
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 1:2220 AVE U
Mailing Address - Street 2:APT.#1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3648
Mailing Address - Country:US
Mailing Address - Phone:718-934-7081
Mailing Address - Fax:
Practice Address - Street 1:1009 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5659
Practice Address - Country:US
Practice Address - Phone:718-975-8500
Practice Address - Fax:718-975-8502
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02723182Medicaid
NY5620B1Medicare ID - Type Unspecified
NY02723182Medicaid