Healthcare Provider Details

I. General information

NPI: 1871132969
Provider Name (Legal Business Name): ALLEN C OGRAM NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 TILTON RD
NORTHFIELD NJ
08225-1877
US

IV. Provider business mailing address

569 HOLLY BROOK DR
GALLOWAY NJ
08205-2905
US

V. Phone/Fax

Practice location:
  • Phone: 609-407-4797
  • Fax:
Mailing address:
  • Phone: 609-334-9236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01004800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: