OLENA KSOVRELI PHYSICIAN PC
Osteopathic Medicine at Ridge Blvd, Brooklyn, NY

License number
New York 221578
Category
Osteopathic Medicine
Type
Internal Medicine
Owner
Name: OLENA KSOVRELI MD
Title: PRESIDENT
Phone: (718) 745-1236
Address
Address
6735 Ridge Blvd, Brooklyn, NY 11220
National Provider ID: 1700026911
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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OLENA KSOVRELI, PHYSICIAN, PC

67-35 Rdg Blvd, Brooklyn, NY 11220

Status:
Inactive
Inactive reason:
Dissolution
Registration:
Feb 2, 2009
Inactive since:
Aug 10, 2012
State ID:
3770069
Business type:
DOMESTIC PROFESSIONAL CORPORATION

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