Individual
ANDREY KOLESNIKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
586 MIDLAND AVE STE 1B, STATEN ISLAND, NY 10306-5901
(465) 987-7916
(646) 437-5457
Mailing address
586 MIDLAND AVE STE 1B, STATEN ISLAND, NY 10306-5901
(465) 987-7916
(646) 437-5457
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
287701
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
287701
NY MEDICAL LICENSE
NY
Enumeration date
06/09/2008
Last updated
09/22/2021
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