MEDICARE: MRS. KATTIA OLENDER 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	207R00000X	Internal Medicine Physician	214953-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265479786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATTIA OLENDER MD

Provider Business Mailing Address
First Line	:	160 E 56TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-3609
Country	:	US
Telephone Number	:	212-421-6509
Fax Number	:	212-421-6504

Provider Business Practice Location Address
First Line	:	160 E 56TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-3609
Country	:	US
Telephone Number	:	212-421-6509
Fax Number	:	212-421-6504

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/27/2010

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