Provider Demographics
NPI:1639992340
Name:GNATIUK, OLENA (RDH)
Entity type:Individual
Prefix:
First Name:OLENA
Middle Name:
Last Name:GNATIUK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 NEPTUNE AVE APT 5C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4007
Mailing Address - Country:US
Mailing Address - Phone:646-617-2324
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVE RM 405
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-0444
Practice Address - Country:US
Practice Address - Phone:917-781-0318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033149124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist