Provider Demographics
NPI:1659404259
Name:OFGANG, SETH (MA CCCA)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:OFGANG
Suffix:
Gender:M
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 ELM STREET
Mailing Address - Street 2:SUITE #4
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3403
Mailing Address - Country:US
Mailing Address - Phone:631-271-6263
Mailing Address - Fax:631-271-2062
Practice Address - Street 1:44 ELM STREET
Practice Address - Street 2:SUITE #4
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3403
Practice Address - Country:US
Practice Address - Phone:631-271-6263
Practice Address - Fax:631-271-2062
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0016751237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY218004POtherHIP
NY113502OtherVYTRA
NY16751OtherEMPIRE
NYM90671OtherBCBS
NY16751OtherEMPIRE