Provider Demographics
NPI:1386773034
Name:OFGANG, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:OFGANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 NORTH ST
Mailing Address - Street 2:STE 323
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5628
Mailing Address - Country:US
Mailing Address - Phone:203-798-0533
Mailing Address - Fax:
Practice Address - Street 1:57 NORTH ST
Practice Address - Street 2:STE 323
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5628
Practice Address - Country:US
Practice Address - Phone:203-798-0533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330830-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2E7441Medicare ID - Type Unspecified