Healthcare Provider Details

I. General information

NPI: 1831286574
Provider Name (Legal Business Name): TADAO OGURA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 OLD COUNTRY ROAD SUITE 233
GARDEN CITY NY
11530-2011
US

IV. Provider business mailing address

600 OLD COUNTRY ROAD SUITE 233
GARDEN CITY NY
11530-2011
US

V. Phone/Fax

Practice location:
  • Phone: 516-745-0001
  • Fax: 516-745-1463
Mailing address:
  • Phone: 516-745-0001
  • Fax: 516-745-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number117722
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: