Provider Demographics
NPI:1053874719
Name:GAVARUKHINA, OLGA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:GAVARUKHINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 KINGS HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1722
Mailing Address - Country:US
Mailing Address - Phone:718-612-7999
Mailing Address - Fax:
Practice Address - Street 1:427 KINGS HWY STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1722
Practice Address - Country:US
Practice Address - Phone:718-612-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No171R00000XOther Service ProvidersInterpreterGroup - Multi-Specialty