Provider Demographics
NPI:1467555425
Name:OGRADY, JOHN WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:OGRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E 74TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3535
Mailing Address - Country:US
Mailing Address - Phone:212-861-5200
Mailing Address - Fax:212-737-2190
Practice Address - Street 1:112 E 74TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3535
Practice Address - Country:US
Practice Address - Phone:212-861-5200
Practice Address - Fax:212-737-2190
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000635587OtherUNITED HEALTH CARE
NYNP849OtherOXFORD
NY000635587OtherUNITED HEALTH CARE
NY633141Medicare ID - Type Unspecified