Lidia Mikolaenko

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

57241 Issued in CT

Practice address

80 Phoenix Ave Ste 201
Waterbury, CT 06702-1418

Phone

(203) 756-8021

NPI assigned

Apr 19, 2014

Last updated

Oct 5, 2026By the provider in NPPES

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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

  dba Mount Sinai Doctors Long Island

  • 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": "1791158400000",
    "number": "1497175228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 PHOENIX AVE STE 201",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021418",
            "telephone_number": "203-756-8021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 PHOENIX AVE STE 201",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021418",
            "telephone_number": "203-756-8021"
        }
    ],
    "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"
        },
        {
            "address_1": "59 Southern Blvd",
            "address_purpose": "LOCATION",
            "city": "Nesconset",
            "state": "NY",
            "postal_code": "117671090",
            "country_code": "US",
            "telephone_number": "631-628-5000",
            "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": "2026-10-05",
        "certification_date": "2026-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "290112",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "57241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Z Fein DPM PC
• Kiley Doyle Michaels
• Jenna M Michaud
• Middle CT Emergency Physicians LLC
• Tanya Miko, MSW
• Jaclyn Milano, PA-C
• Jesse D Miller-Khodik, LPC
• Diane Swensen Miller, M.D.
• Dwight F Miller, MD
• Elizabeth Miller, RDH

• Family Medicine Physician in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2026; 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.