Provider Demographics
NPI:1538508833
Name:OLIVER, JENNIFER MARIE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 GREYSTONE AVE
Mailing Address - Street 2:A1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 GREYSTONE AVE
Practice Address - Street 2:A1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1937
Practice Address - Country:US
Practice Address - Phone:917-930-9812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator