Provider Demographics
NPI:1982906269
Name:CEDRIC K. OLIVERA, MD, PLLC
Entity Type:Organization
Organization Name:CEDRIC K. OLIVERA, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:K
Authorized Official - Last Name:OLIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-222-2600
Mailing Address - Street 1:PO BOX 26481
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11202-6481
Mailing Address - Country:US
Mailing Address - Phone:718-222-2600
Mailing Address - Fax:718-222-4194
Practice Address - Street 1:175 REMSEN ST
Practice Address - Street 2:SUITE 1225
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4300
Practice Address - Country:US
Practice Address - Phone:718-222-2600
Practice Address - Fax:718-222-4194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236536207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty