Provider Demographics
NPI:1457798506
Name:OLEFSON, SIDNEY
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:
Last Name:OLEFSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 STATE ROUTE 50
Mailing Address - Street 2:
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027-9511
Mailing Address - Country:US
Mailing Address - Phone:518-831-1500
Mailing Address - Fax:518-377-1677
Practice Address - Street 1:848 STATE ROUTE 50
Practice Address - Street 2:
Practice Address - City:BURNT HILLS
Practice Address - State:NY
Practice Address - Zip Code:12027-9511
Practice Address - Country:US
Practice Address - Phone:518-831-1500
Practice Address - Fax:518-377-1677
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT56817207R00000X, 390200000X
MA278384207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program