Provider Demographics
NPI:1255434635
Name:KRIVITSKY, OLGA (MD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KRIVITSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 WHEELER DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003
Mailing Address - Country:US
Mailing Address - Phone:504-888-2945
Mailing Address - Fax:504-469-1979
Practice Address - Street 1:4224 HOUMA BLVD STE 470
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2980
Practice Address - Country:US
Practice Address - Phone:504-456-5160
Practice Address - Fax:504-469-1979
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL14028R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1484733Medicaid
LAP00266138OtherMEDICARE RAIL ROAD
LAP00266138OtherMEDICARE RAIL ROAD
LA1484733Medicaid
LA4A893Medicare PIN