Healthcare Provider Details

I. General information

NPI: 1841485364
Provider Name (Legal Business Name): CRISTIANO OLIVEIRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 YORK AVE 11TH FLOOR
NEW YORK NY
10021-5663
US

IV. Provider business mailing address

1305 YORK AVE 11TH FLOOR
NEW YORK NY
10021-5663
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-4297
  • Fax: 646-962-0600
Mailing address:
  • Phone: 646-962-4297
  • Fax: 646-962-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number259239
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number249153
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number259239
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number259239
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: