Provider Demographics
NPI:1639262975
Name:ONGSIAKO, MARIA VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:ONGSIAKO
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 1:420 BRIDGE PLAZA DR # A
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-1735
Mailing Address - Country:US
Mailing Address - Phone:732-617-2222
Mailing Address - Fax:732-617-2223
Practice Address - Street 1:420 BRIDGE PLAZA DR # A
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1735
Practice Address - Country:US
Practice Address - Phone:732-617-2222
Practice Address - Fax:732-617-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA053924002084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF18997Medicare UPIN
NJ565306Medicare ID - Type Unspecified