Provider Demographics
NPI:1992069207
Name:LOZOVETSKAYA, OLGA (MSED)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:LOZOVETSKAYA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 RADFORD ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4812
Mailing Address - Country:US
Mailing Address - Phone:917-443-9344
Mailing Address - Fax:
Practice Address - Street 1:120 RADFORD ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4812
Practice Address - Country:US
Practice Address - Phone:917-443-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1152249252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency