MEDICARE: DR. OLGA ORLOV M.D.

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	2080A0000X	Pediatric Adolescent Medicine Physician	MA044803	NJ

General Provider Information

NPI Number	:	1407813215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLGA ORLOV M.D.

Provider Business Mailing Address
First Line	:	6 DUDLEY CT
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-8462
Country	:	US
Telephone Number	:	973-633-9756
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 HAMBURG TPKE
Second Line	:	SUITE 107
City	:	WAYNE
State	:	NJ
Zip	:	07470-8482
Country	:	US
Telephone Number	:	973-942-0541
Fax Number	:	973-942-9542

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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