Healthcare Provider Details

I. General information

NPI: 1770121121
Provider Name (Legal Business Name): LEAH OGRODNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 COUNTY ROAD 520
ENGLISHTOWN NJ
07726-8475
US

IV. Provider business mailing address

27 BITTNER RD
MILLSTONE TOWNSHIP NJ
08535-1206
US

V. Phone/Fax

Practice location:
  • Phone: 732-972-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: