Provider Demographics
NPI:1023358538
Name:OLIVER, ELIZABETH TOVA (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TOVA
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10 CLOVERDALE LN
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2401
Mailing Address - Country:US
Mailing Address - Phone:845-352-3486
Mailing Address - Fax:
Practice Address - Street 1:3141 45TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-1621
Practice Address - Country:US
Practice Address - Phone:718-274-2600
Practice Address - Fax:718-274-1772
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016393-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant