Healthcare Provider Details

I. General information

NPI: 1144319864
Provider Name (Legal Business Name): ANTHONY D OLIVIERI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3371 RICHMOND AVE
STATEN ISLAND NY
10312-2025
US

IV. Provider business mailing address

3371 RICHMOND AVE
STATEN ISLAND NY
10312-2025
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-4246
  • Fax: 718-948-3591
Mailing address:
  • Phone: 718-948-4246
  • Fax: 718-948-3591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberNY004952
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: