Provider Demographics
NPI:1720194038
Name:OLIVA, DIOSMARY AHAGENCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIOSMARY
Middle Name:AHAGENCIA
Last Name:OLIVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 WORTH STREET BOX 22 RM 901
Mailing Address - Street 2:NYCDOHMH DIVISION OF DISEASE CONTROL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4006
Mailing Address - Country:US
Mailing Address - Phone:212-442-5465
Mailing Address - Fax:212-442-8452
Practice Address - Street 1:CHEST CLINIC CORONA DISTRICT HEALTH CENTER
Practice Address - Street 2:34-33 JUNCTION BLVD
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-426-2635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY209949207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0105BHMedicare ID - Type UnspecifiedGHI
H81232Medicare UPIN
NY118AD1Medicare ID - Type UnspecifiedEMPIRE
NY010JBGMedicare ID - Type UnspecifiedGHI