Provider Demographics
NPI:1174564157
Name:OLSON, TY JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:TY
Middle Name:JAMES
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 HOPE ROAD 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724
Mailing Address - Country:US
Mailing Address - Phone:732-222-8866
Mailing Address - Fax:732-544-2068
Practice Address - Street 1:745 HOPE ROAD 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724
Practice Address - Country:US
Practice Address - Phone:732-222-8866
Practice Address - Fax:732-544-2068
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220840207T00000X
NJ25MA07930500207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery