Lidia Mikolaenko

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

290112 Issued in NY

Practice address

59 Southern Blvd
Nesconset, NY 11767-1090

Phone

(631) 628-5000

NPI assigned

Apr 19, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Shore Medical Group of the Mount Sinai School of Medicine

  • Internal Medicine Physician
  • Greenlawn, NY
  • NPI 1275640609

  Family Medicine

  Medicare reassignment NPD
• North Shore Medical Group of the Mount Sinai School of Medicine

  • Internal Medicine Physician
  • Wantagh, NY
  • NPI 1992417323

  Family Medicine

  NPD

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

{
    "created_epoch": "1397865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669593600000",
    "number": "1497175228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 SOUTHERN BLVD",
            "city": "NESCONSET",
            "state": "NY",
            "postal_code": "117671090",
            "telephone_number": "631-628-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 SOUTHERN BLVD",
            "city": "NESCONSET",
            "state": "NY",
            "postal_code": "117671090",
            "telephone_number": "631-628-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3125 Transverse Dr",
            "address_2": "Health Science Campus Health Center",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436148008",
            "country_code": "US",
            "telephone_number": "419-383-3771",
            "fax_number": "419-383-3162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIKOLAENKO",
        "first_name": "LIDIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-19",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "290112",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "57241",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bradley Ross Meltzer, O.D.
• Barbara Memos, R.N.
• Rebecca Rayanne Merenda, PSY.D.
• Sarah Maria Metri
• Peter Gregg Michaelson, M.D.
• Jamie Misegades, PT, DPT
• Yvonne Moeller, RN
• Vinessa Ann Monaco, RN
• Stephanie Charis Moore
• Morning Star Home Health Agency, Inc

• Family Medicine Physician in Nesconset, NY
• Providers in Nesconset, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.