Provider Demographics
NPI:1548621097
Name:REID, OLGA (NP)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GARDEN CITY PLZ
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3322
Mailing Address - Country:US
Mailing Address - Phone:516-746-3633
Mailing Address - Fax:
Practice Address - Street 1:400 GARDEN CITY PLZ
Practice Address - Street 2:SUITE 107
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3322
Practice Address - Country:US
Practice Address - Phone:516-746-3633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF360219-1363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology