Provider Demographics
NPI:1033578026
Name:O'GARA, BRITTANY LAURA (PA-C)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LAURA
Last Name:O'GARA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6124
Mailing Address - Country:US
Mailing Address - Phone:631-742-1981
Mailing Address - Fax:
Practice Address - Street 1:148 MERRICK RD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3439
Practice Address - Country:US
Practice Address - Phone:631-841-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant