MEDICARE: RUBEN OLMEDO MD

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	207PT0002X	Medical Toxicology (Emergency Medicine) Physician	27804	NY
2	207P00000X	Emergency Medicine Physician	203456 1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	930099986	OTHER	NY	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831164680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBEN OLMEDO MD

Provider Business Mailing Address
First Line	:	BOX 1149
Second Line	:	ONE GUSTAVE LEVY PLACE
City	:	NEW YORK
State	:	NY
Zip	:	10029
Country	:	US
Telephone Number	:	212-241-0101
Fax Number	:	212-426-5083

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PL FL 12
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6574
Country	:	US
Telephone Number	:	917-595-9920
Fax Number	:

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/23/2022

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Directions to “ RUBEN OLMEDO MD” Practice Location

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