Provider Demographics
NPI:1831322577
Name:OLENEN, PETER DMYTRI (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DMYTRI
Last Name:OLENEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 S PLANK RD
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10998-2807
Mailing Address - Country:US
Mailing Address - Phone:845-726-3675
Mailing Address - Fax:
Practice Address - Street 1:486 S PLANK RD
Practice Address - Street 2:
Practice Address - City:WESTTOWN
Practice Address - State:NY
Practice Address - Zip Code:10998-2807
Practice Address - Country:US
Practice Address - Phone:845-726-3675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1243382083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine