Healthcare Provider Details

I. General information

NPI: 1427103241
Provider Name (Legal Business Name): SHARON DANE OGISTE-MCBAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5018 AVENUE D
BROOKLYN NY
11203-5906
US

IV. Provider business mailing address

4802 CLARENDON RD
BROOKLYN NY
11203-5208
US

V. Phone/Fax

Practice location:
  • Phone: 718-451-2800
  • Fax: 718-451-2804
Mailing address:
  • Phone: 718-345-1420
  • Fax: 718-451-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number217597
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: