Healthcare Provider Details

I. General information

NPI: 1750341897
Provider Name (Legal Business Name): PRINCEWILL O OGBUJI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RIVER ST SUITE 201
VALATIE NY
12184-9694
US

IV. Provider business mailing address

1301 RIVER ST SUITE 201
VALATIE NY
12184-9694
US

V. Phone/Fax

Practice location:
  • Phone: 518-758-2055
  • Fax: 518-758-2057
Mailing address:
  • Phone: 518-758-2055
  • Fax: 518-758-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number200573-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: