Provider Demographics
NPI:1588739585
Name:GUTNIK, OLEG (MD)
Entity type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:GUTNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1616 VOORHIES AVE
Mailing Address - Street 2:# A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3914
Mailing Address - Country:US
Mailing Address - Phone:718-332-5678
Mailing Address - Fax:718-934-1780
Practice Address - Street 1:1616 VOORHIES AVE
Practice Address - Street 2:# A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3914
Practice Address - Country:US
Practice Address - Phone:718-332-5678
Practice Address - Fax:718-934-1780
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY163630207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A63833Medicare UPIN
690451Medicare ID - Type Unspecified