Provider Demographics
NPI:1720221229
Name:OGORCHOCK-CONGILOSI, JESSICA E (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:E
Last Name:OGORCHOCK-CONGILOSI
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 1:4855 CAMP ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075
Mailing Address - Country:US
Mailing Address - Phone:315-591-0910
Mailing Address - Fax:
Practice Address - Street 1:4855 CAMP RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2600
Practice Address - Country:US
Practice Address - Phone:716-646-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264071-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine