Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 051096 | NY |
Y | 1223P0300X | Periodontist | 22DI02358500 | NJ |
NPI | 1003098724 |
---|---|
Provider Name | Dr. Olga Michaud |
First Address | Paramus, NJ 07652-5346 |
Second Address | Fort Lee, NJ 07024-5059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2007 |
Last Update Date | 05/12/2007 |