Healthcare Provider Details

I. General information

NPI: 1750584496
Provider Name (Legal Business Name): HOWARD M OGIN LIC. PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1096 N CHURCH ST ROUTE 309
HAZLE TOWNSHIP PA
18202-1410
US

IV. Provider business mailing address

1096 N CHURCH ST ROUTE 309
HAZLE TOWNSHIP PA
18202-1410
US

V. Phone/Fax

Practice location:
  • Phone: 570-455-6115
  • Fax: 570-455-6119
Mailing address:
  • Phone: 570-455-6115
  • Fax: 570-455-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS006704L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: