Provider Demographics
NPI:1700845187
Name:UKRAINSKY, GENNADY (MD)
Entity Type:Individual
Prefix:
First Name:GENNADY
Middle Name:
Last Name:UKRAINSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:UKRAINSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2625
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8925
Mailing Address - Country:US
Mailing Address - Phone:914-471-3422
Mailing Address - Fax:646-928-2360
Practice Address - Street 1:10812 72ND AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7079
Practice Address - Country:US
Practice Address - Phone:718-544-9300
Practice Address - Fax:718-544-9301
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234912174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02661567Medicaid
NY7M8401Medicare PIN
NYI28594Medicare UPIN