Provider Demographics
NPI:1194247338
Name:DE JESUS, OLGA NOEMI (EDD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:NOEMI
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5400
Mailing Address - Country:US
Mailing Address - Phone:917-622-4757
Mailing Address - Fax:
Practice Address - Street 1:74 LAFAYETTE DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5400
Practice Address - Country:US
Practice Address - Phone:917-622-4757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist