Provider Demographics
NPI:1407592223
Name:OJAKOVO, ESE ROY
Entity Type:Individual
Prefix:
First Name:ESE
Middle Name:ROY
Last Name:OJAKOVO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W ROSEDALE ST APT 202
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3564
Mailing Address - Country:US
Mailing Address - Phone:202-631-7310
Mailing Address - Fax:
Practice Address - Street 1:259 1ST ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-8443
Practice Address - Fax:516-663-8955
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program