Provider Demographics
NPI:1215971908
Name:OLSEN, DREW (MD)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-0511
Mailing Address - Country:US
Mailing Address - Phone:845-294-4339
Mailing Address - Fax:845-294-4333
Practice Address - Street 1:255 LAFAYETTE AVE
Practice Address - Street 2:GOOD SAMARITAN HOSPITAL
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-368-5179
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221176207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH23079Medicare UPIN
NY50R122Medicare ID - Type Unspecified