Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 138733 | NY |
NPI | 1073538260 |
---|---|
Provider Name | Dr. Ellen Marie Olson |
First Address | Bronxville, NY 10708 |
Second Address | Bronx, NY 10468 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |