Provider Demographics
NPI:1184640278
Name:OGRADY, MARILYN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:OGRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5730
Mailing Address - Country:US
Mailing Address - Phone:516-248-3698
Mailing Address - Fax:
Practice Address - Street 1:111 7TH ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5731
Practice Address - Country:US
Practice Address - Phone:516-747-3349
Practice Address - Fax:516-747-6003
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155631207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB19118Medicare UPIN
NY73D741Medicare ID - Type Unspecified