Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 25MA08756900 | NJ |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD436175 | PA |
NPI | 1255509873 |
---|---|
Provider Name | Bernard Okem Ogon |
First Address | Burlington, NJ 08016-5155 |
Second Address | Bristol, PA 19007-2514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2008 |
Last Update Date | 08/01/2018 |