Healthcare Provider Details

I. General information

NPI: 1982906269
Provider Name (Legal Business Name): CEDRIC K. OLIVERA, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 REMSEN ST SUITE 1225
BROOKLYN NY
11201-4300
US

IV. Provider business mailing address

PO BOX 26481
BROOKLYN NY
11202-6481
US

V. Phone/Fax

Practice location:
  • Phone: 718-222-2600
  • Fax: 718-222-4194
Mailing address:
  • Phone: 718-222-2600
  • Fax: 718-222-4194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number236536
License Number StateNY

VIII. Authorized Official

Name: DR. CEDRIC K OLIVERA
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 718-222-2600