Healthcare Provider Details

I. General information

NPI: 1609242916
Provider Name (Legal Business Name): ROYSTON OGBUAGU NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 JAY ST STE 501
BROOKLYN NY
11201-4314
US

IV. Provider business mailing address

203 JAY ST STE 501
BROOKLYN NY
11201-4314
US

V. Phone/Fax

Practice location:
  • Phone: 917-416-7490
  • Fax:
Mailing address:
  • Phone: 917-416-7490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number627489-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8718453
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: