Healthcare Provider Details

I. General information

NPI: 1710792726
Provider Name (Legal Business Name): ALEXSANDRA OGURTSOVA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 02/08/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 HEMPSTEAD AVE
STATEN ISLAND NY
10306-6073
US

IV. Provider business mailing address

13 E WINANT AVE
RIDGEFIELD PARK NJ
07660-2015
US

V. Phone/Fax

Practice location:
  • Phone: 347-534-5340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: