Provider Demographics
NPI:1841449709
Name:SHARGORODSKIY, OLEG (LAC)
Entity type:Individual
Prefix:MR
First Name:OLEG
Middle Name:
Last Name:SHARGORODSKIY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1388 W 6TH ST APT E6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4828
Mailing Address - Country:US
Mailing Address - Phone:718-913-6780
Mailing Address - Fax:
Practice Address - Street 1:55 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2427
Practice Address - Country:US
Practice Address - Phone:718-667-7778
Practice Address - Fax:718-667-3705
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist