Healthcare Provider Details

I. General information

NPI: 1487424701
Provider Name (Legal Business Name): WILLIAM J OHARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2432 RIVER RD
NISKAYUNA NY
12309-1104
US

IV. Provider business mailing address

2432 RIVER RD
NISKAYUNA NY
12309-1104
US

V. Phone/Fax

Practice location:
  • Phone: 518-807-4520
  • Fax:
Mailing address:
  • Phone: 518-807-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number230779
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: