1568635506 NPI number — DR. GRETCHEN E OHLIG OD

Table of content: DR. GRETCHEN E OHLIG OD (NPI 1568635506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568635506 NPI number — DR. GRETCHEN E OHLIG OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OHLIG
Provider First Name:
GRETCHEN
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568635506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101A NORTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST NORTHPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11731-1603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-321-9597
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 WHEATLEY PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11548-1316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-686-6512
Provider Business Practice Location Address Fax Number:
516-277-1591
Provider Enumeration Date:
04/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2381 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: T005447 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008053302 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: D400183486 . This is a "MEDICARE NGS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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