Basic Information
| Provider Information | |||||||||
| NPI: | 1780820373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOLY | ||||||||
| FirstName: | OLIVIA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 513 W 166TH ST | ||||||||
| Address2: | FL 4 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100324207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129428500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 710 W 168TH ST | ||||||||
| Address2: | NEURO 12 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059758 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2009 | ||||||||
| LastUpdateDate: | 03/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 258980 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.