Healthcare Provider Details

I. General information

NPI: 1629457718
Provider Name (Legal Business Name): OMS PODIATRY SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10030 DITMARS BLVD RM 325
EAST ELMHURST NY
11369-1333
US

IV. Provider business mailing address

6 OAK CREST DR
HIGHLAND NY
12528-2708
US

V. Phone/Fax

Practice location:
  • Phone: 718-393-7705
  • Fax: 718-446-4547
Mailing address:
  • Phone: 718-393-7705
  • Fax: 718-446-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005924
License Number StateNY

VIII. Authorized Official

Name: KELVIN OGELLE
Title or Position: DPM
Credential:
Phone: 718-399-7705