Provider Demographics
NPI:1194809145
Name:NESHEIWAT, OGLEH I (MD)
Entity type:Individual
Prefix:
First Name:OGLEH
Middle Name:I
Last Name:NESHEIWAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 ROUTE 52 STE 2
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-3533
Mailing Address - Country:US
Mailing Address - Phone:845-765-2404
Mailing Address - Fax:845-765-2406
Practice Address - Street 1:1989 ROUTE 52
Practice Address - Street 2:SUITE 2
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533
Practice Address - Country:US
Practice Address - Phone:845-765-2404
Practice Address - Fax:845-765-2406
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241579208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02811498Medicaid