Provider Demographics
NPI:1982861936
Name:OLA PEDIATRICS PC
Entity Type:Organization
Organization Name:OLA PEDIATRICS PC
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:718-547-7771
Mailing Address - Street 1:3032 CORLEAR AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-548-4040
Mailing Address - Fax:718-548-3939
Practice Address - Street 1:645 ALLERTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-7403
Practice Address - Country:US
Practice Address - Phone:718-547-7771
Practice Address - Fax:718-547-8091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLA PEDIATRICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-19
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211010261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01990770Medicaid
NY146412684OtherNPI
NY146412684OtherNPI