Healthcare Provider Details

I. General information

NPI: 1952810012
Provider Name (Legal Business Name): OLIVIA MARIE EIBERT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA LANGEVIN

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PALISADES DR STE 100
ALBANY NY
12205-6433
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-438-4496
  • Fax:
Mailing address:
  • Phone: 518-525-5634
  • Fax: 518-649-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number021328
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: