Kevin F Olson II, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

139236 Issued in NY

Practice address

48 Route 25a
Suite 210
Smithtown, NY 11787-1431

Phone

(631) 862-3696

Fax

(631) 862-3698

NPI assigned

Jul 20, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279670400000",
    "number": "1629077722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 ROUTE 25A",
            "address_2": "SUITE 210",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117871431",
            "telephone_number": "631-862-3696",
            "fax_number": "631-862-3698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 ROUTE 25A",
            "address_2": "SUITE 210",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117871431",
            "telephone_number": "631-862-3696",
            "fax_number": "631-862-3698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "KEVIN",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2010-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "139236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00970347",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dayna Patrice Ofgang, M.A.
• Tara Ohare, LCSW
• Jennifer Ann Olesuk, PHARMD
• Chrystyne Olivieri, DNP
• Thomas J Olivo, LCSW
• Omni Medical 360 PLLC
• Omni Physical Therapy
• Oprx #11787, LLC
• Optima Care Smithtown LLC
• Optimum Care Family Medicine, LLC

• Internal Medicine Physician in Smithtown, NY
• Providers in Smithtown, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.