Healthcare Provider Details

I. General information

NPI: 1144948415
Provider Name (Legal Business Name): WENDY S OCHOA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

302 SUMMIT AVE
MOUNT VERNON NY
10552-3004
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7000
  • Fax:
Mailing address:
  • Phone: 347-430-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: