MEDICARE: MIMI OLIFF PA-C

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	363AS0400X	Surgical Physician Assistant	014398	NY

General Provider Information

NPI Number	:	1568772093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIMI OLIFF PA-C

Provider Business Mailing Address
First Line	:	347 MOUNT PLEASANT AVE STE 103
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2745
Country	:	US
Telephone Number	:	973-571-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	347 MOUNT PLEASANT AVE STE 103
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2745
Country	:	US
Telephone Number	:	973-571-2121
Fax Number	:

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

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	03/29/2019

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Directions to “ MIMI OLIFF PA-C” Practice Location

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