Provider Demographics
NPI:1770786873
Name:OLIVETO, FRANK D (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:D
Last Name:OLIVETO
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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-0038
Mailing Address - Country:US
Mailing Address - Phone:631-928-0522
Mailing Address - Fax:631-928-2675
Practice Address - Street 1:9 HEMLOCK PATH
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1018
Practice Address - Country:US
Practice Address - Phone:631-928-0522
Practice Address - Fax:631-928-2675
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096990207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB16190Medicare UPIN
NY537221Medicare ID - Type Unspecified