Provider Demographics
NPI:1891037578
Name:RICHARDSON-OLIVIER, CHALESE KATCHE (MD)
Entity Type:Individual
Prefix:
First Name:CHALESE
Middle Name:KATCHE
Last Name:RICHARDSON-OLIVIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHALESE
Other - Middle Name:KATCHE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHALESE RICHARDSON
Mailing Address - Street 1:1111 MARCUS AVE STE M15
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1034
Mailing Address - Country:US
Mailing Address - Phone:516-601-7200
Mailing Address - Fax:516-601-7380
Practice Address - Street 1:1111 MARCUS AVE STE M15
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1034
Practice Address - Country:US
Practice Address - Phone:516-601-7200
Practice Address - Fax:516-601-7380
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
PAMD4670132080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program