Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | MC03186 | NJ |
N | 111NX0800X | Chiropractor Orthopedic Specialist | MC03186 | NJ |
NPI | 1043224090 |
---|---|
Provider Name | Dr. Robert Stanley Olivieri |
First Address | Rio Grande, NJ 08242-1401 |
Second Address | Rio Grande, NJ 08242-1401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0099307000 | 10-DIGIT HMO ID (01) | NJ |
T44915 | (02) | NJ |