Provider Demographics
NPI:1780176099
Name:OLIVEROS, NAPOLEON PRESTOZA JR (RPT)
Entity type:Individual
Prefix:MR
First Name:NAPOLEON
Middle Name:PRESTOZA
Last Name:OLIVEROS
Suffix:JR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24 KELLOGG RD APT 30
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3179
Mailing Address - Country:US
Mailing Address - Phone:347-283-6977
Mailing Address - Fax:
Practice Address - Street 1:7 KEELER AVE
Practice Address - Street 2:
Practice Address - City:MORAVIA
Practice Address - State:NY
Practice Address - Zip Code:13118-3688
Practice Address - Country:US
Practice Address - Phone:315-497-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038232-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist