Provider Demographics
NPI:1023868882
Name:NAVAKOVICH, OLGA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:NAVAKOVICH
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 1:490 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1911
Mailing Address - Country:US
Mailing Address - Phone:201-981-3388
Mailing Address - Fax:
Practice Address - Street 1:79 NY-59, SUITE 3
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:201-981-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353177164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse