Healthcare Provider Details

I. General information

NPI: 1619758638
Provider Name (Legal Business Name): IFEOMA O OGU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IFEOMA O ECHEZONA OGU RN

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 QUEENS PLZ N
LONG ISLAND CITY NY
11101-4172
US

IV. Provider business mailing address

19449 112TH AVE
SAINT ALBANS NY
11412-2022
US

V. Phone/Fax

Practice location:
  • Phone: 718-391-8300
  • Fax:
Mailing address:
  • Phone: 347-238-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number791282
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: