Provider Demographics
NPI:1811942220
Name:SLUPCHYNSKYJ, OLEH (MD)
Entity type:Individual
Prefix:
First Name:OLEH
Middle Name:
Last Name:SLUPCHYNSKYJ
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 1:44 E 65TH ST
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7022
Mailing Address - Country:US
Mailing Address - Phone:212-628-6464
Mailing Address - Fax:
Practice Address - Street 1:44 E 65TH ST
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7022
Practice Address - Country:US
Practice Address - Phone:212-628-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ69922207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01744930Medicaid
NY01744930Medicaid