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Individual

LIDIA MIKOLAENKO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
59 SOUTHERN BLVD, NESCONSET, NY 11767-1090
(631) 628-5000
Mailing address
59 SOUTHERN BLVD, NESCONSET, NY 11767-1090
(631) 628-5000

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
290112
NY
207Q00000X
Family Medicine Physician
57241
CT

Other

Enumeration date
04/19/2014
Last updated
11/28/2022
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