Provider Demographics
NPI:1053583682
Name:ORG MEDICAL PLLC
Entity type:Organization
Organization Name:ORG MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYULENEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-538-9844
Mailing Address - Street 1:99 MOORE ST
Mailing Address - Street 2:UNIT 1- Z
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-3302
Mailing Address - Country:US
Mailing Address - Phone:917-538-9844
Mailing Address - Fax:
Practice Address - Street 1:99 MOORE ST
Practice Address - Street 2:UNIT 1- Z
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-3302
Practice Address - Country:US
Practice Address - Phone:917-538-9844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9K5581207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty