Healthcare Provider Details

I. General information

NPI: 1972182160
Provider Name (Legal Business Name): ISRAEL OJALVO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4966 BROADWAY # 1
NEW YORK NY
10034-2318
US

IV. Provider business mailing address

4966 BROADWAY # 1
NEW YORK NY
10034-2318
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number323691
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: