Provider Demographics
NPI:1659556116
Name:GONIK, OLEG GREGORY
Entity Type:Individual
Prefix:MR
First Name:OLEG
Middle Name:GREGORY
Last Name:GONIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3801
Mailing Address - Country:US
Mailing Address - Phone:718-469-3311
Mailing Address - Fax:718-928-7262
Practice Address - Street 1:2011 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3801
Practice Address - Country:US
Practice Address - Phone:718-469-3311
Practice Address - Fax:718-928-7262
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006985156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA10001590Medicare PIN