Provider Demographics
NPI:1326233701
Name:AOL MEDICAL SERVICES P.C.
Entity Type:Organization
Organization Name:AOL MEDICAL SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-331-4511
Mailing Address - Street 1:3704 91ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7909
Mailing Address - Country:US
Mailing Address - Phone:607-331-4511
Mailing Address - Fax:718-899-1250
Practice Address - Street 1:12929 WESTSIDE VILLAGE LOOP
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6779
Practice Address - Country:US
Practice Address - Phone:607-331-4511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY240621OtherPHYSICIAN LICENSE