Healthcare Provider Details

I. General information

NPI: 1447136247
Provider Name (Legal Business Name): JOHN MIKE OGANDO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LYONS AVE
NEWARK NJ
07112-2027
US

IV. Provider business mailing address

700 SCHUYLER AVE APT E11
KEARNY NJ
07032-4249
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-7000
  • Fax:
Mailing address:
  • Phone: 203-578-6056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00953700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: