Healthcare Provider Details

I. General information

NPI: 1841524089
Provider Name (Legal Business Name): OGONTZ FAMILY MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7622 OGONTZ AVE
PHILADELPHIA PA
19150-1817
US

IV. Provider business mailing address

7622 OGONTZ AVE
PHILADELPHIA PA
19150-1817
US

V. Phone/Fax

Practice location:
  • Phone: 215-224-8980
  • Fax: 215-893-4704
Mailing address:
  • Phone: 215-224-8980
  • Fax: 215-893-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY LINCOW
Title or Position: GENERAL MANAGER
Credential:
Phone: 215-224-8980