Provider Demographics
NPI:1932435468
Name:PHYLLIS OLSHANSKY INC
Entity Type:Organization
Organization Name:PHYLLIS OLSHANSKY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:MACKLIN
Authorized Official - Last Name:OLSHANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:914-636-8051
Mailing Address - Street 1:60 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2506
Mailing Address - Country:US
Mailing Address - Phone:914-636-8051
Mailing Address - Fax:914-636-6957
Practice Address - Street 1:60 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2506
Practice Address - Country:US
Practice Address - Phone:914-636-8051
Practice Address - Fax:914-636-6957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-17
Last Update Date:2009-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4079261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01653227Medicaid