Healthcare Provider Details

I. General information

NPI: 1396945622
Provider Name (Legal Business Name): DR. DOROTHY NENE OGUNDU, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

11455 FARMERS BLVD 1ST FLOOR
SAINT ALBANS NY
11412-2740
US

IV. Provider business mailing address

11455 FARMERS BLVD 1ST FLOOR
SAINT ALBANS NY
11412-2740
US

V. Phone/Fax

Practice location:
  • Phone: 718-776-9699
  • Fax:
Mailing address:
  • Phone: 718-776-9699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number167797-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number167797-1
License Number StateNY

VIII. Authorized Official

Name: DR. DOROTHY N OGUNDU
Title or Position: PRESIDENT
Credential: M.D
Phone: 718-776-9699