Provider Demographics
NPI:1114989548
Name:OLIVIER, WENDY ANN (M D)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:ANN
Last Name:OLIVIER
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BROOKDALE PLAZA
Mailing Address - Street 2:PHYSICIAN ENTERPRISE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-2907
Mailing Address - Country:US
Mailing Address - Phone:718-240-7413
Mailing Address - Fax:718-240-5808
Practice Address - Street 1:1 HANSON PL STE 710
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11243-2907
Practice Address - Country:US
Practice Address - Phone:718-783-0934
Practice Address - Fax:718-240-5808
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217393208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2159295Medicaid
NY2159295Medicaid
NYH41922Medicare UPIN