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General NPI Number Information
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NPI Number | 1982861936
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Entity Type | Organization
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Legal Business Name | OLA PEDIATRICS PC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 10/11/2013
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Provider Practice Location Address
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Address Line | 645 ALLERTON AVE
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City | BRONX
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State | NY
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Zip | 10467-7403
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Country | US
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Telephone | 718-547-7771
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Fax | 718-547-8091
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Provider Business Mailing Address
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Address Line | 3032 CORLEAR AVE FIRST FLOOR
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City | BRONX
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State | NY
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Zip | 10463
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Country | US
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Telephone | 718-548-4040
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Fax | 718-548-3939
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANA OLIVERO
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Credential | MD
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Telephone | 718-547-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 211010
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License Number State | NY
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