Provider Demographics
NPI:1528897261
Name:PALITAVA, OLGA (NP)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:PALITAVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 VETERANS MEMORIAL HWY STE C
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7613
Mailing Address - Country:US
Mailing Address - Phone:631-676-7656
Mailing Address - Fax:631-676-7648
Practice Address - Street 1:3505 VETERANS MEMORIAL HWY STE C
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7613
Practice Address - Country:US
Practice Address - Phone:631-676-7656
Practice Address - Fax:631-676-7648
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF354918363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily