Oleg Antonov MD PC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

OLEG ANTONOV MD PC

Practice address

11400 Bustleton Ave
Philadelphia, PA 19116

Phone

(215) 111-1111

NPI assigned

Jul 9, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Oleg Antonov, MD

Title

Owner

Phone

(215) 111-1111

Specialties & licenses 1

Addresses

Other names 1

• 11400 Bustleton Avenue Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373328000000",
    "number": "1396186201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11400 BUSTLETON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191162815",
            "telephone_number": "215-111-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11400 BUSTLETON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19116",
            "telephone_number": "215-111-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLEG ANTONOV MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-09",
        "last_updated": "2013-07-09",
        "status": "A",
        "authorized_official_last_name": "ANTONOV",
        "authorized_official_first_name": "OLEG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-111-1111",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "11400 Bustleton Avenue",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Olde Main Operator LLC
• Cherie Older, L.C.S.W.
• Derek Alan Oldridge, M.D., PH.D.
• Olivia Oldridge, MD
• Juan A. Oleaga, MD
• Oleg Antonov MD PC
• Oleg Volchonok, MD, PC
• Barbara Olejnik, OT
• Tressa Cecilia Olek, M.S., CCC-SLP
• Dina M Oleksiak, CRNP

• Specialist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.