Provider Demographics
NPI:1790180982
Name:KARAVATSKI, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KARAVATSKI
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 1:19 HERITAGE DR APT H
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5341
Mailing Address - Country:US
Mailing Address - Phone:845-729-0417
Mailing Address - Fax:
Practice Address - Street 1:19 HERITAGE DR APT H
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5341
Practice Address - Country:US
Practice Address - Phone:845-729-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1191789174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist