Provider Demographics
NPI:1437302833
Name:HELIOTIS OLSEN, EMILY JUNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:JUNE
Last Name:HELIOTIS OLSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE STE 3100N
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:241 NORTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1154
Practice Address - Country:US
Practice Address - Phone:914-909-9018
Practice Address - Fax:914-909-9028
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027044363AS0400X, 2086S0127X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008610401Medicaid
FLP946423OtherOPTIMUM
FLP01176026OtherRAILROAD MCR
FL9335999OtherAETNA
FLP0016099OtherFLORIDA HEALTHCARE PLUS
FLP1006512OtherFREEDOM HEALTH
FLY0H3MOtherBCBS OF FL
FL5111129OtherCIGNA
FL27369OtherMEDICA