Provider Demographics
NPI:1780814681
Name:MASAGBOR, OMANAMHE (MD)
Entity Type:Individual
Prefix:
First Name:OMANAMHE
Middle Name:
Last Name:MASAGBOR
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 1:165 N VILLAGE AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3763
Mailing Address - Country:US
Mailing Address - Phone:516-255-3773
Mailing Address - Fax:
Practice Address - Street 1:165 N VILLAGE AVE
Practice Address - Street 2:STE 140
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3763
Practice Address - Country:US
Practice Address - Phone:516-255-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-26
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0033162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry