Provider Demographics
NPI:1780841924
Name:OLA PEDIATRICS
Entity Type:Organization
Organization Name:OLA PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-548-4040
Mailing Address - Street 1:3032 CORLEAR AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5141
Mailing Address - Country:US
Mailing Address - Phone:718-548-4040
Mailing Address - Fax:718-548-3939
Practice Address - Street 1:3032 CORLEAR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5141
Practice Address - Country:US
Practice Address - Phone:718-548-4040
Practice Address - Fax:718-548-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01990770Medicaid
NYH10445Medicare UPIN
NY1467412684OtherNPI