Provider Demographics
NPI:1124469390
Name:ABUSERIDZE, OLGA
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:ABUSERIDZE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:ANDZEEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2145 OCEAN AVENUE, APT. 9A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:347-549-5958
Mailing Address - Fax:
Practice Address - Street 1:2145 OCEAN AVENUE, APT. 9A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:347-549-5958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA00649374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide