Provider Demographics
NPI:1013914514
Name:OLIVIERI, KAREN L (PA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:OLIVIERI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1730
Mailing Address - Country:US
Mailing Address - Phone:631-261-4445
Mailing Address - Fax:631-261-3710
Practice Address - Street 1:325 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1730
Practice Address - Country:US
Practice Address - Phone:631-261-4445
Practice Address - Fax:631-261-3710
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008469363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4F9081OtherMEDICARE LEGACY
NY4F9081OtherBLUE CROSS/BLUE SHIELD
NY02383080Medicaid
P41684Medicare UPIN
NY4F9081OtherMEDICARE LEGACY