Provider Demographics
NPI:1801250675
Name:OLIVERA, ALEX JOSEPH
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:JOSEPH
Last Name:OLIVERA
Suffix:
Gender:M
Credentials:
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 825159
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5159
Mailing Address - Country:US
Mailing Address - Phone:301-933-7133
Mailing Address - Fax:
Practice Address - Street 1:2130 HIGHWAY 35
Practice Address - Street 2:BUILDING C SUITE 312
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1010
Practice Address - Country:US
Practice Address - Phone:732-974-8200
Practice Address - Fax:732-974-0190
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01676213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist