Provider Demographics
NPI:1154439073
Name:OLSEFSKI, JANE (PA)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:OLSEFSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CREAMERY RD
Mailing Address - Street 2:PO BOX 60
Mailing Address - City:SLATERVILLE SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14881
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:821 CLIFF ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2017
Practice Address - Country:US
Practice Address - Phone:607-277-2170
Practice Address - Fax:607-277-2329
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA2243Medicare PIN
NYS96189Medicare UPIN