Healthcare Provider Details

I. General information

NPI: 1922466101
Provider Name (Legal Business Name): LYDIA OGAJA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 B NETHERLAND AVENUE
STATEN ISLAND NY
10303
US

IV. Provider business mailing address

176B NETHERLAND AVE
STATEN ISLAND NY
10303-2508
US

V. Phone/Fax

Practice location:
  • Phone: 347-221-2898
  • Fax:
Mailing address:
  • Phone: 347-221-2898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number662723
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR17313300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: