Provider Demographics
NPI:1871684860
Name:AIRPORT MEDICAL OFFICES AT JFK
Entity Type:Organization
Organization Name:AIRPORT MEDICAL OFFICES AT JFK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSHANETSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-244-1644
Mailing Address - Street 1:23059 INT'L AIRPORT CENTER BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11413
Mailing Address - Country:US
Mailing Address - Phone:718-244-1644
Mailing Address - Fax:718-244-1622
Practice Address - Street 1:23059 INT'L AIRPORT CENTER BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11413-1644
Practice Address - Country:US
Practice Address - Phone:718-244-1644
Practice Address - Fax:718-244-1622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215014-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12U061Medicare ID - Type Unspecified
HO3523Medicare UPIN