Basic Information
| Provider Information | |||||||||
| NPI: | 1639695091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OVIASOGIE | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | OSEMWENGIE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 430 NIAGARA ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142011886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168562587 | ||||||||
| FaxNumber: | 7168562608 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 NIAGARA ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142011886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168562587 | ||||||||
| FaxNumber: | 7168562608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 699520 | NY | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 402562 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.