Ny Female Pelvic Reconstructive Surgery PLLC

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

236536 Issued in NY

Legal business name

NY FEMALE PELVIC RECONSTRUCTIVE SURGERY PLLC

Practice address

7203 13TH Ave
Brooklyn, NY 11228

Phone

(718) 238-5454

NPI assigned

Jul 25, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cedric Olivera, MDNPI 1568638997

Title

Managing Member

Phone

(718) 238-5454

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cedric Keir Olivera, MD, MS

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • New York, NY
  • NPI 1568638997
  Medicare reassignment Authorized official
• Oxana Djalilov, FNP

  • Family Nurse Practitioner
  • Bethlehem, PA
  • NPI 1790518306
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534723200000",
    "number": "1093292864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7203 13TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112282008",
            "telephone_number": "718-238-5454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7203 13TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11228",
            "telephone_number": "718-238-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NY FEMALE PELVIC RECONSTRUCTIVE SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-25",
        "last_updated": "2018-08-20",
        "status": "A",
        "authorized_official_last_name": "OLIVERA",
        "authorized_official_first_name": "CEDRIC",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "718-238-5454",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NY",
            "license": "236536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03052540",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gynecology Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Gynecology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.