Provider Demographics
NPI:1669622296
Name:VERBITSKIY, OLGA (FNP-BC)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:VERBITSKIY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:PRADUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-729-2209
Practice Address - Street 1:116 N JENSEN RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2128
Practice Address - Country:US
Practice Address - Phone:607-766-0100
Practice Address - Fax:607-766-0102
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03281867Medicaid