Healthcare Provider Details

I. General information

NPI: 1114067337
Provider Name (Legal Business Name): KELVIN OGELLE D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 88TH ST
JACKSON HEIGHTS NY
11372-7630
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 Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN005924-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: