Individual
OLEG OTLIVANCHIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-4321
Mailing address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-4321
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
310459
NY
2084V0102X
Vascular Neurology Physician
310459
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/16/2016
Last updated
06/05/2025
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