Provider Demographics
NPI:1689492464
Name:MARTIN OVIASOGIE NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity type:Organization
Organization Name:MARTIN OVIASOGIE NURSE PRACTITIONER IN PSYCHIATRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OVIASOGIE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:315-767-5272
Mailing Address - Street 1:95 WILLIAM PRICE PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1400
Mailing Address - Country:US
Mailing Address - Phone:315-551-1602
Mailing Address - Fax:
Practice Address - Street 1:3610 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14226-3123
Practice Address - Country:US
Practice Address - Phone:315-551-1602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty