IVAN MIKOLAENKO (NPI# 1023231883) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023231883 |
| Entity Type | Individual |
| Full Name | IVAN MIKOLAENKO |
| Credential | M.D. |
| Practice Address |
100 Merrick Road Suite 128 Rockville Centre NY 11570-0001 |
| Mailing Address |
100 Merrick Rd Ste 128 Rockville Centre NY 11570-4821 |
| Practice Telephone | 5162559031 |
| Practice Fax Number | 5167662306 |
| Mailing Telephone | 5162559031 |
| Mailing Fax Number | 5167662306 |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2012-04-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
0109542061 | VA | Allopathic & Osteopathic Physicians |
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
0116020711 | VA | Allopathic & Osteopathic Physicians |
| N | 2084V0102X |
Psychiatry & Neurology Specialization: Vascular Neurology |
0116020711 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 1023231883 | 05 |
| Street Address |
100 MERRICK ROAD SUITE 128 |
| City | ROCKVILLE CENTRE |
| State | NY |
| Zip Code | 11570-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811462419 | Jessica Ilana Smuckler | Occupational Therapist | 90 S Park Ave Apt C2, Rockville Centre, NY 11570 | 2018-10-10 |
| 1356831309 | Pure Medical Services PC | Specialist | 2000 N Village Ave Ste 202, Rockville Centre, NY 11570 | 2018-05-15 |
| 1447766449 | Licura, LLC | Technician, Other | 566 Merrick Road, Suite 1, Rockville Centre, NY 11570 | 2017-12-28 |
| 1427505858 | Shera M Goodridge | Specialist | 134 Shellbank Place, Rockville Center, NY 11570 | 2016-09-01 |
| 1669830634 | Barbara Massina, Lcsw | Clinic/Center | 161 N Village Ave, Rockville Centre, NY 11570 | 2016-02-05 |
| 1972973428 | Medscript Pharmacy LLC | Pharmacy | 180-184 Sunrise Highway, Rockville Centre, NY 11570 | 2015-09-28 |
| 1265813703 | Jeffrey Michael Nozius | Registered Nurse | 1000 Hempstead Ave, Rockville Centre, NY 11570 | 2015-06-10 |
| 1568855971 | Meredith Kreinbihl | Counselor | 119 North Park Avenue, Suite 210, Rockville Centre, NY 11570 | 2015-03-09 |
| 1174921647 | Pamela Leake | Behavioral Analyst | 88 Hendrickson Ave, Rvc, NY 11570 | 2014-12-15 |
| 1467851584 | Lisa Brown-eisel, Lcsw, P.C. | Social Worker | 100 North Village Avenue, Suite 32, Rockville Centre, NY 11570 | 2014-08-14 |
| Find all providers in zip 11570 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831115179 | Angelito Durano Tan | Psychiatry & Neurology | 2000 North Village Avenue, Ste 202, Rockville Centre, NY 11570 | 2006-07-13 |
| 1841420544 | Mazurek Memory Systems, Inc. | Psychiatry & Neurology | 371 Merrick Rd, Suite 401, Rockville Centre, NY 11570-5359 | 2009-07-16 |
| 1801082219 | Angelito D. Tan, M.d., PC | Psychiatry & Neurology | 2000 N Village Ave, Ste 202, Rockville Centre, NY 11570-1078 | 2007-09-19 |
| 1184737744 | Poonam S Dulai | Psychiatry & Neurology | 2000 N Village Ave, Suite 309, Rockville Centre, NY 11570-1078 | 2006-08-17 |
| 1457335697 | Julius Bazan | Psychiatry & Neurology | 165 N Village Ave, Ste 129, Rockville Centre, NY 11570-3761 | 2005-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124638275 | Oversight Physician Services Pllc | Psychiatry & Neurology | 198 Sussex Dr, Manhasset, NY 11030-3737 | 2020-08-04 |
| 1841818234 | Padmaja Aradhya Md Pllc | Psychiatry & Neurology | 17 Dillon Dr, Dix Hills, NY 11746-7945 | 2020-07-11 |
| 1184279085 | All Island Neurology PC | Psychiatry & Neurology | 11617 Atlantic Ave, Richmond Hill, NY 11418-3141 | 2019-08-07 |
| 1346802352 | Ny Neurology Medicine PC | Psychiatry & Neurology | 305 7th Ave Rm 13c, New York, NY 10001-6155 | 2019-07-01 |
| 1770144636 | Upstate Neurology P.C. | Psychiatry & Neurology | 804 Syska Rd, Ossining, NY 10562-1424 | 2019-06-21 |
| 1659836518 | David T Finkelstein | Psychiatry & Neurology | 3619 Bedford Ave Apt 1b, Brooklyn, NY 11210-5254 | 2019-02-05 |
| 1801360029 | Ghassan George Haddad | Psychiatry & Neurology | 20 Waterside Plz Apt 26e, New York, NY 10010-2665 | 2019-01-22 |
| 1427527472 | Daniel Ahoubim Md PC | Psychiatry & Neurology | 37 W 26th St Rm 204, New York, NY 10010-1145 | 2018-11-20 |
| 1053889378 | Paul Wright, M.d. | Psychiatry & Neurology | 500 N Broadway Ste 16, Jericho, NY 11753-2127 | 2018-11-05 |
| 1770096109 | Wpw Medical, Pllc | Psychiatry & Neurology | 280 Dobbs Ferry Rd Ste 206, White Plains, NY 10607-1912 | 2017-11-07 |
| Find all providers with the same taxonomy | ||||
| City | ROCKVILLE CENTRE |
| Zip Code | 11570 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.