Provider Demographics
NPI:1710647862
Name:SANOTSKY, OLYA
Entity Type:Individual
Prefix:MRS
First Name:OLYA
Middle Name:
Last Name:SANOTSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 RIDGEWOOD PKWY W
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2825
Mailing Address - Country:US
Mailing Address - Phone:973-368-7149
Mailing Address - Fax:
Practice Address - Street 1:25 RIDGEWOOD PKWY W
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2825
Practice Address - Country:US
Practice Address - Phone:973-368-7149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01240300363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty