Provider Demographics
NPI:1306078431
Name:OLGA ORLOV, MD PA
Entity type:Organization
Organization Name:OLGA ORLOV, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-942-0521
Mailing Address - Street 1:508 HAMBURG TPKE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8482
Mailing Address - Country:US
Mailing Address - Phone:973-942-0521
Mailing Address - Fax:
Practice Address - Street 1:508 HAMBURG TPKE
Practice Address - Street 2:SUITE 107
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8482
Practice Address - Country:US
Practice Address - Phone:973-942-0521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0448032080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty