Eolb Medical Group Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

EOLB MEDICAL GROUP INC

Practice address

16927 Vanowen St Ste 4
Lake Balboa, CA 91406-4582

Phone

(818) 483-4717

NPI assigned

Dec 6, 2018

Organization subpart

No

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

Authorized official

Name

Eugene Ostrovsky, M. D.

Title

President/ Medical Director

Phone

(818) 960-5334

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1544054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548288000000",
    "number": "1881165546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18180 ANDREA CIR N UNIT 5",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251107",
            "telephone_number": "818-960-5334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16927 VANOWEN ST STE 4",
            "city": "LAKE BALBOA",
            "state": "CA",
            "postal_code": "914064582",
            "telephone_number": "818-483-4717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EOLB MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-06",
        "last_updated": "2019-01-24",
        "status": "A",
        "authorized_official_last_name": "OSTROVSKY",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_title_or_position": "PRESIDENT/ MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-960-5334",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Lake Balboa, CA
• Providers in Lake Balboa, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; 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.