Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 210665 | NY |
Y | 207Q00000X | Family Doctor | 210665 | NY |
NPI | 1255359253 |
---|---|
Provider Name | Michael Fredrick Oliverio |
First Address | North Bellmore, NY 11710-1832 |
Second Address | North Bellmore, NY 11710-1832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 06/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01955857 | (05) | NY |
G72498 | (02) |