Healthcare Provider Details

I. General information

NPI: 1275827263
Provider Name (Legal Business Name): OGHENEOCHUKO E. METITIRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 SOUTH RD
POUGHKEEPSIE NY
12601-5458
US

IV. Provider business mailing address

110 S BEDFORD RD
MOUNT KISCO NY
10549-3446
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-3111
  • Fax: 845-432-3919
Mailing address:
  • Phone: 914-241-1050
  • Fax: 914-242-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number289095
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: