Healthcare Provider Details

I. General information

NPI: 1568638997
Provider Name (Legal Business Name): CEDRIC KEIR OLIVERA MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MAIDEN LN FL 3
NEW YORK NY
10038-4831
US

IV. Provider business mailing address

PO BOX 26481
BROOKLYN NY
11202-6481
US

V. Phone/Fax

Practice location:
  • Phone: 646-290-9560
  • Fax: 212-532-4362
Mailing address:
  • Phone: 732-740-4495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number236536-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMA66558
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number236536
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: