Basic Information
| Provider Information | |||||||||
| NPI: | 1114989548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVIER | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BROOKDALE PLAZA | ||||||||
| Address2: | PHYSICIAN ENTERPRISE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112122907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182407413 | ||||||||
| FaxNumber: | 7182405808 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HANSON PL STE 710 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112432907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187830934 | ||||||||
| FaxNumber: | 7182405808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 217393 | NY | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2159295 | 05 | NY | MEDICAID |