1982906269 NPI number — CEDRIC K. OLIVERA, MD, PLLC

Table of content: (NPI 1982906269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982906269 NPI number — CEDRIC K. OLIVERA, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDRIC K. OLIVERA, MD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982906269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26481
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11202-6481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-222-2600
Provider Business Mailing Address Fax Number:
718-222-4194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 REMSEN ST
Provider Second Line Business Practice Location Address:
SUITE 1225
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-222-2600
Provider Business Practice Location Address Fax Number:
718-222-4194
Provider Enumeration Date:
11/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVERA
Authorized Official First Name:
CEDRIC
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
718-222-2600

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  236536 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com