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NPI Code Detail

MEDICARE: DR. RENITA OGLESBY D.O.

MEDICARE: DR. RENITA OGLESBY D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QA0505XAdult Medicine Physician25MB08472400NJ

General Provider Information

NPI Number : 1548450851
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RENITA OGLESBY D.O.
Provider Business Mailing Address
First Line : 7O UNION AVENUE
Second Line : APT. 4
City : NUTLEY
State : NJ
Zip : 07110
Country : US
Telephone Number : 973-592-2733
Fax Number :
Provider Business Practice Location Address
First Line : 1 MEDICAL CENTER DR
Second Line :
City : STRATFORD
State : NJ
Zip : 08084-1500
Country : US
Telephone Number : 973-592-2733
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2007
Last Update Date : 08/05/2016

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