Healthcare Provider Details

I. General information

NPI: 1275119836
Provider Name (Legal Business Name): OLIVIA QUESTORE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 BRICK BLVD
BRICK NJ
08723-6077
US

IV. Provider business mailing address

2200 ARCH ST UNIT 713
PHILADELPHIA PA
19103-1344
US

V. Phone/Fax

Practice location:
  • Phone: 732-701-4848
  • Fax:
Mailing address:
  • Phone: 908-309-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MB12411100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: