Healthcare Provider Details

I. General information

NPI: 1740574839
Provider Name (Legal Business Name): PATIENCE OGBONNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 UTICA AVE
BROOKLYN NY
11203-1916
US

IV. Provider business mailing address

PO BOX 670177
BRONX NY
10467-0810
US

V. Phone/Fax

Practice location:
  • Phone: 646-342-1293
  • Fax:
Mailing address:
  • Phone: 646-342-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number023952
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: