Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N005924-1 | NY |
NPI | 1114067337 |
---|---|
Provider Name | Dr. Kelvin Ogelle |
First Address | Highland, NY 12528-2708 |
Second Address | Jackson Heights, NY 11372-7630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 18/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00612404 | RAILROAD MEDICARE PIN (01) | NY |
U93025 | (02) | NY |