Healthcare Provider Details

I. General information

NPI: 1194844704
Provider Name (Legal Business Name): OLGA HIGBEE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/07/2023
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD HSC, L-4, RM 050
STONY BROOK NY
11794-8350
US

IV. Provider business mailing address

101 NICOLLS RD HSC, L-4, RM 050
STONY BROOK NY
11794-8350
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2478
  • Fax:
Mailing address:
  • Phone: 631-444-2478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3618
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number003618
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009439
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: