=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770786873
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANK D OLIVETO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 HEMLOCK PATH
-----------------------------------------------------
City | PORT JEFFERSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11777-1018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-928-0522
-----------------------------------------------------
Fax | 631-928-2675
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 38
-----------------------------------------------------
City | PORT JEFFERSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11777-0038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-928-0522
-----------------------------------------------------
Fax | 631-928-2675
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 096990
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------