Provider Demographics
NPI:1629264114
Name:WESTBURY MEDICAL GROUP PC
Entity Type:Organization
Organization Name:WESTBURY MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-258-7700
Mailing Address - Street 1:11 MELRICK CT
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2425
Mailing Address - Country:US
Mailing Address - Phone:718-258-7700
Mailing Address - Fax:
Practice Address - Street 1:1915 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6801
Practice Address - Country:US
Practice Address - Phone:718-258-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02083269Medicaid
NYW35171Medicare PIN
NY02083269Medicaid