Mikolaenko, Ivan

Mikolaenko, Ivan is an individual health care provider with primary practice located at 100 Merrick Road Suite 128 , Rockville Centre NY 11570-0001. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurology, Allopathic & Osteopathic Physicians / Vascular Neurology. Allopathic & Osteopathic Physicians / Neurology is his primary health care specialty. Mikolaenko, Ivan can be contacted via phone (516) 255-9031.

Contact Information

Primary practice address
100 Merrick Road Suite 128 Rockville Centre NY 11570-0001
Phone: (516) 255-9031
Fax: (516) 766-2306
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 0116020711 Virginia
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 0109542061 Virginia
Allopathic & Osteopathic Physicians / Vascular Neurology 2084V0102X 0116020711 Virginia

Profile Details

NPI number 1023231883
LBN Legal business name Mikolaenko, Ivan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 10th, 2007
Last updated Apr 5th, 2012 - about 12 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 1023231883 NPPES
Virginia MEDICAID 1023231883

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