Provider Demographics
NPI:1518106889
Name:KOLESNIKOV, ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:KOLESNIKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 W 2ND ST
Mailing Address - Street 2:APT 5G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6363
Mailing Address - Country:US
Mailing Address - Phone:718-891-2139
Mailing Address - Fax:
Practice Address - Street 1:2511 OCEAN AVE
Practice Address - Street 2:STE 102
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3950
Practice Address - Country:US
Practice Address - Phone:718-301-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253976-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine