| Doctor Name: | IVAN MIKOLAENKO |
| NPI Number: | 1023231883 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 0116020711 |
| Business Practice Address: | 100 Merrick Road Suite 128 Rockville Centre, NY - 115700001 |
| Business Phone Number: | 5162559031 |
| Business Fax Number: | 5167662306 |
| Mailing Address: | 100 Merrick Rd Ste 128, ROCKVILLE CENTRE |
| State: | NY |
| Postal Code: | 115704821 |
| Phone Number: | 5162559031 |
| Fax Number: | 5167662306 |
| NPI Enumeration Date: | 04/10/2007 |
| NPI Last Update Date: | 04/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084N0400X |
| License Number: | 0116020711 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Neurology |
| Taxonomy Definition: | A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |