Bolotova, Olena

Bolotova, Olena is an individual health care provider with primary practice located at 260 Patchogue Yaphank Rd , East Patchogue NY 11772-4886. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Nephrology. Allopathic & Osteopathic Physicians / Nephrology is her primary health care specialty. Bolotova, Olena can be contacted via phone (631) 654-8755.

Contact Information

Primary practice address
260 Patchogue Yaphank Rd East Patchogue NY 11772-4886
Phone: (631) 654-8755
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 311738 New York

Profile Details

NPI number 1417300732
LBN Legal business name Bolotova, Olena
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 21st, 2016
Last updated Aug 22nd, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417300732 NPPES
New York Other A400268620 MEDICARE

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