Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 236536 | NY |
N | 207VG0400X | Gynecologist | 236536-1 | NY |
N | 207VG0400X | Gynecologist | MA66558 | NJ |
NPI | 1568638997 |
---|---|
Provider Name | Dr. Cedric Keir Olivera |
First Address | Brooklyn, NY 11202-6481 |
Second Address | New York, NY 10038-4831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2008 |
Last Update Date | 21/11/2017 |