# GLEN OAKS INTERNAL MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255721924
- **Authorized official:** DR. OLGA KOURUKLIS M.D. (PRACTICE OWNER)
- **Authorized official phone:** (718) 347-7090

## Contact information

- **Practice address:** 26004 80TH AVE, GLEN OAKS, NY 11004-1502
- **Practice address phone:** (718) 347-7090
- **Practice address fax:** (718) 343-1453
- **Mailing address:** 26004 80TH AVE, GLEN OAKS, NY 11004-1502
- **Mailing address phone:** (718) 347-7090
- **Mailing address fax:** (718) 343-1453

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 244811 | NY | Yes |

## Other

- **Enumeration date:** 02/02/2015
- **Last updated:** 12/14/2015