MEDICARE: DR. JOSE MANUEL SANTOS OLIVARES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	342155-01	NY

General Provider Information

NPI Number	:	1164162400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE MANUEL SANTOS OLIVARES MD

Provider Business Mailing Address
First Line	:	506 LENOX AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10037-1889
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 E 149TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5504
Country	:	US
Telephone Number	:	443-642-9456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2022
Last Update Date	:	06/08/2026

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