Provider Demographics
NPI:1841486545
Name:GENNADY UKRAINSKY MD PC
Entity type:Organization
Organization Name:GENNADY UKRAINSKY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-471-3422
Mailing Address - Street 1:PO BOX 2625
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8925
Mailing Address - Country:US
Mailing Address - Phone:914-471-3422
Mailing Address - Fax:
Practice Address - Street 1:108-12 72ND AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7080
Practice Address - Country:US
Practice Address - Phone:718-544-9300
Practice Address - Fax:718-544-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
NY207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6712550001Medicare NSC