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General NPI Number Information
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NPI Number | 1710247796
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Entity Type | Individual
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Provider Name | LEONA OGO DEVIN L.AC.
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Gender | Female
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 7 NEW LAKE RD
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City | VALLEY COTTAGE
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State | NY
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Zip | 10989-1868
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Country | US
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Telephone | 845-893-2747
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Fax |
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Provider Business Mailing Address
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Address Line | 19 PARK AVE
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City | CONGERS
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State | NY
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Zip | 10920-1519
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25 004819
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License Number State | NY
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