Basic Information
| Provider Information | |||||||||
| NPI: | 1841485364 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLIVEIRA | ||||||||
| FirstName: | CRISTIANO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 YORK AVE | ||||||||
| Address2: | 11TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100215663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469624297 | ||||||||
| FaxNumber: | 6469620600 | ||||||||
| Practice Location | |||||||||
| Address1: | 1305 YORK AVE | ||||||||
| Address2: | 11TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100215663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469624297 | ||||||||
| FaxNumber: | 6469620600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2007 | ||||||||
| LastUpdateDate: | 05/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 259239 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 390200000X | 259239 | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | 249153 | MA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207WX0109X | 259239 | NY | Y |
No ID Information.