Provider Demographics
NPI:1225003916
Name:OGILVIE, JENNIFER BRAEMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BRAEMAR
Last Name:OGILVIE
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 1:530 1ST AVE
Mailing Address - Street 2:HCC 6H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-7710
Mailing Address - Fax:212-263-2828
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:HCC 6H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-7710
Practice Address - Fax:212-263-2828
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253188208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400012438OtherMEDICARE, PTAN