Provider Demographics
NPI:1942680517
Name:GUSKOVA, OLGA (PA-C)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:GUSKOVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 OLYMPIA BLVD
Mailing Address - Street 2:UNIT A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4233
Mailing Address - Country:US
Mailing Address - Phone:347-782-8207
Mailing Address - Fax:
Practice Address - Street 1:329 OLYMPIA BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4233
Practice Address - Country:US
Practice Address - Phone:347-782-8207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018621363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant