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General NPI Number Information
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NPI Number | 1235951112
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Entity Type | Individual
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Provider Name | OLIVIA ROSE LEROY
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Gender | Female
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 535 E 70TH ST
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City | NEW YORK
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State | NY
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Zip | 10021-4823
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Country | US
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Telephone | 212-606-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 57 GLENMERE DR
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City | CHATHAM
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State | NJ
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Zip | 07928-1305
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Country | US
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Telephone | 973-699-5049
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02264100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05314801
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License Number State | NY
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