Provider Demographics
NPI:1508291394
Name:OLP MEDICAL CONSULTANT
Entity Type:Organization
Organization Name:OLP MEDICAL CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRYNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-327-1874
Mailing Address - Street 1:2628 BROADWAY APT 15B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5009
Mailing Address - Country:US
Mailing Address - Phone:908-327-1874
Mailing Address - Fax:
Practice Address - Street 1:2628 BROADWAY APT 15B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5009
Practice Address - Country:US
Practice Address - Phone:908-327-1874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261798207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty