Healthcare Provider Details

I. General information

NPI: 1811143738
Provider Name (Legal Business Name): BARBARA ANN OGRADY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 HAWTHORNE ROAD
KINGS PARK NY
11754
US

IV. Provider business mailing address

100 WALNUT STREET
LAKE GROVE NY
11755
US

V. Phone/Fax

Practice location:
  • Phone: 631-656-6312
  • Fax:
Mailing address:
  • Phone: 631-656-6312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number483797-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: