Provider Demographics
NPI:1104072586
Name:BURZYANTSEVA, OLGA A (MD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:A
Last Name:BURZYANTSEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9608
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11555-9608
Mailing Address - Country:US
Mailing Address - Phone:718-261-0444
Mailing Address - Fax:718-261-0940
Practice Address - Street 1:12510 QUEENS BLVD
Practice Address - Street 2:STE 2701
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1519
Practice Address - Country:US
Practice Address - Phone:718-261-0444
Practice Address - Fax:718-261-0940
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-17
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
NY271151207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology