Provider Demographics
NPI:1386180461
Name:OLENA MEDICAL NEW JERSEY LLC
Entity Type:Organization
Organization Name:OLENA MEDICAL NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARSHVARDHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAOBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-255-6391
Mailing Address - Street 1:694 MAIN ST # 257
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0027
Mailing Address - Country:US
Mailing Address - Phone:718-255-6391
Mailing Address - Fax:
Practice Address - Street 1:143 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-2001
Practice Address - Country:US
Practice Address - Phone:718-255-6391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09008400207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty