1205996188 NPI number — DR. RITA M OLIVERIO PHD

Table of content: DR. RITA M OLIVERIO PHD (NPI 1205996188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205996188 NPI number — DR. RITA M OLIVERIO PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLIVERIO
Provider First Name:
RITA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLIVERIO
Provider Other First Name:
RITA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1205996188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 732
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFTON PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12065-0732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-373-2208
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
96 APPLETREE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFTON PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12065-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-373-2208
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  012458 , 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)

  • Identifier: 098793 . This is a "MAGELLAN PIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: V0987 . This is a "EMPIRE BLUE CROSS PIN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 0005514236 . This is a "AETNA PIN #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 40188 . This is a "CIGNABEHAVIORAL PIN NUMBE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6803835 . This is a "GHI MAGELLAN PIN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 112014 . This is a "VALUEOPTIONS PIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 41200 . This is a "MVP HEALTHCARE PIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000470553003 . This is a "BLUESHIELD NENY PIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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