Provider Demographics
NPI:1386772754
Name:BELOSTOTSKY, OLGA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:BELOSTOTSKY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E 82ND ST APT 11C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4916
Mailing Address - Country:US
Mailing Address - Phone:917-573-3224
Mailing Address - Fax:212-988-3443
Practice Address - Street 1:47 E 77TH ST STE 201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1730
Practice Address - Country:US
Practice Address - Phone:646-688-3443
Practice Address - Fax:646-688-4332
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226767207RR0500X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI41155Medicare UPIN
NY4255FYTWZ1Medicare PIN