MEDICARE: DR. OLIVE C OSBORNE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	206441	NY

General Provider Information

NPI Number	:	1144258146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLIVE C OSBORNE M.D.

Provider Business Mailing Address
First Line	:	2426 EASTCHESTER RD
Second Line	:	SUITE 203
City	:	BRONX
State	:	NY
Zip	:	10469-5916
Country	:	US
Telephone Number	:	718-708-7142
Fax Number	:	347-202-7161

Provider Business Practice Location Address
First Line	:	2426 EASTCHESTER RD
Second Line	:	SUITE 203
City	:	BRONX
State	:	NY
Zip	:	10469-5916
Country	:	US
Telephone Number	:	718-708-7142
Fax Number	:	347-202-7161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	08/16/2017

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