Healthcare Provider Details

I. General information

NPI: 1184341554
Provider Name (Legal Business Name): MR. THOMAS OGERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17220 HIGHLAND AVE APT 2
JAMAICA NY
11432-2865
US

IV. Provider business mailing address

17220 HIGHLAND AVE APT 2
JAMAICA NY
11432-2865
US

V. Phone/Fax

Practice location:
  • Phone: 917-318-2170
  • Fax:
Mailing address:
  • Phone: 917-318-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number005635
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: