Provider Demographics
NPI:1063160943
Name:VYSOCHEK, OLENA
Entity type:Individual
Prefix:
First Name:OLENA
Middle Name:
Last Name:VYSOCHEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORBIN PL APT 2P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4931
Mailing Address - Country:US
Mailing Address - Phone:917-412-6878
Mailing Address - Fax:
Practice Address - Street 1:200 CORBIN PL APT 2P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4931
Practice Address - Country:US
Practice Address - Phone:917-412-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist