Provider Demographics
NPI:1700404720
Name:MEDICAL DOCTOR MILENA KOLESNIKOVA PC
Entity Type:Organization
Organization Name:MEDICAL DOCTOR MILENA KOLESNIKOVA PC
Other - Org Name:MEDICAL DOCTOR MILENA KOLESNIKOVA PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLESNIKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:980-330-2025
Mailing Address - Street 1:586 MIDLAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5903
Mailing Address - Country:US
Mailing Address - Phone:646-598-7791
Mailing Address - Fax:
Practice Address - Street 1:586 MIDLAND AVE STE B
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5903
Practice Address - Country:US
Practice Address - Phone:646-598-7791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty