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General NPI Number Information
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NPI Number | 1902979354
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Entity Type | Individual
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Provider Name | JORGE ARIEL OLDAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 777 SEAVIEW AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3436
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Country | US
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Telephone | 718-667-2591
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Fax |
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Provider Business Mailing Address
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Address Line | 243 W 70TH ST APT 3A
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City | NEW YORK
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State | NY
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Zip | 10023-4318
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Country | US
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Telephone | 212-787-4119
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 123393
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License Number State | NY
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