Provider Demographics
NPI:1457650970
Name:OLAF HAROLDSON, MD, PC
Entity Type:Organization
Organization Name:OLAF HAROLDSON, MD, PC
Other - Org Name:DR. HAROLDSON EAR, NOSE & THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAF
Authorized Official - Middle Name:
Authorized Official - Last Name:HAROLDSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:609-655-5505
Mailing Address - Street 1:7 CENTRE DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1565
Mailing Address - Country:US
Mailing Address - Phone:609-655-5505
Mailing Address - Fax:609-655-5521
Practice Address - Street 1:7 CENTRE DR
Practice Address - Street 2:SUITE 12
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1565
Practice Address - Country:US
Practice Address - Phone:609-655-5505
Practice Address - Fax:609-655-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01798500207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty