Healthcare Provider Details

I. General information

NPI: 1306300736
Provider Name (Legal Business Name): SARA ARIEL OGUREK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LAKEVILLE RD STE 303
NEW HYDE PARK NY
11042-1104
US

IV. Provider business mailing address

410 LAKEVILLE RD STE 303
NEW HYDE PARK NY
11042-1104
US

V. Phone/Fax

Practice location:
  • Phone: 516-321-7555
  • Fax: 516-775-4796
Mailing address:
  • Phone: 516-321-7555
  • Fax: 516-775-4796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number023210
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: