Healthcare Provider Details

I. General information

NPI: 1871610337
Provider Name (Legal Business Name): DR. KRISTIN L OGNIBENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE ST RM 4270
ENGLEWOOD NJ
07631-1808
US

IV. Provider business mailing address

3959 BROADWAY DIV, PED CRITICAL CARE - CHN 1024
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3414
  • Fax:
Mailing address:
  • Phone: 212-305-8458
  • Fax: 212-342-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number225135
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number25MA09068400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: