Provider Demographics
NPI:1952532970
Name:IVANUTENKO, OLESIA (AUD)
Entity Type:Individual
Prefix:DR
First Name:OLESIA
Middle Name:
Last Name:IVANUTENKO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:
Other - Last Name:IVANUTENKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1163 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1213
Mailing Address - Country:US
Mailing Address - Phone:516-484-0811
Mailing Address - Fax:718-514-7403
Practice Address - Street 1:330 E 39TH ST
Practice Address - Street 2:#14R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2187
Practice Address - Country:US
Practice Address - Phone:732-801-6984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002270231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist