Healthcare Provider Details

I. General information

NPI: 1457321416
Provider Name (Legal Business Name): MARTIN OGULNICK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 GIDNEY AVE
NEWBURGH NY
12550-3701
US

IV. Provider business mailing address

410 GIDNEY AVE
NEWBURGH NY
12550-3701
US

V. Phone/Fax

Practice location:
  • Phone: 845-565-5072
  • Fax:
Mailing address:
  • Phone: 845-565-5072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number006711
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: