Healthcare Provider Details

I. General information

NPI: 1013914514
Provider Name (Legal Business Name): KAREN L OLIVIERI P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MAIN ST
NORTHPORT NY
11768-1730
US

IV. Provider business mailing address

325 MAIN ST
NORTHPORT NY
11768-1730
US

V. Phone/Fax

Practice location:
  • Phone: 631-261-4445
  • Fax: 631-261-3710
Mailing address:
  • Phone: 631-261-4445
  • Fax: 631-261-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008469
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: