Active NPI
Michael Olla, M.D.
- Psychiatry Physician
- Fort Lee, NJ
National Provider Identifier
1437406816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 25MA10982700
- Practice address
- 1036 Briar Way
Fort Lee, NJ 07024-6351 - Phone
- (212) 729-9928
- Fax
- (201) 224-3627
- NPI assigned
- Aug 5, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | AB2268301168 | NJ | |
| Psychiatry Physician | 2084P0800X | 25MA10982700 | NJ | Primary |
Addresses
Primary practice location
1036 Briar Way
Fort Lee, NJ 07024-6351
Mailing address
1036 Briar Way
Fort Lee, NJ 07024-6351
Phone (212) 729-9928
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 13, 2023 through Jan 13, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA10982700 | NJ | MD | Psychiatry Physician |
| AB2268301168 | NJ | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626652800000",
"number": "1437406816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1036 BRIAR WAY",
"city": "FORT LEE",
"state": "NJ",
"postal_code": "070246351",
"telephone_number": "212-729-9928",
"fax_number": "201-224-3627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1036 BRIAR WAY",
"city": "FORT LEE",
"state": "NJ",
"postal_code": "070246351",
"telephone_number": "212-729-9928",
"fax_number": "201-224-3627"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLLA",
"first_name": "MICHAEL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-05",
"last_updated": "2021-07-19",
"certification_date": "2021-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NJ",
"license": "AB2268301168",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NJ",
"license": "25MA10982700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lee, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.