MEDICARE: MR. STEPHEN OGALA PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	401741	NY

General Provider Information

NPI Number	:	1588068290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN OGALA PMHNP

Provider Business Mailing Address
First Line	:	229 ROUTE 202
Second Line	:	APT. 6A
City	:	POMONA
State	:	NY
Zip	:	10970-2606
Country	:	US
Telephone Number	:	914-584-0064
Fax Number	:	914-584-0064

Provider Business Practice Location Address
First Line	:	60 N MADISON AVENUE
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-4811
Country	:	US
Telephone Number	:	914-584-0064
Fax Number	:	914-584-0064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2014
Last Update Date	:	10/09/2014

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