Provider Demographics
NPI:1265916480
Name:GINDINOVA, OLGA
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:GINDINOVA
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:PO BOX 140009
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-0009
Mailing Address - Country:US
Mailing Address - Phone:347-922-0118
Mailing Address - Fax:718-837-3564
Practice Address - Street 1:8006 20TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1809
Practice Address - Country:US
Practice Address - Phone:347-922-0118
Practice Address - Fax:718-837-3564
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2050546-DCA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment