Basic Information
| Provider Information | |||||||||
| NPI: | 1326566704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ONGLENGCO | ||||||||
| FirstName: | JERICHO | ||||||||
| MiddleName: | MIKHAIL S | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ONGLENGCO | ||||||||
| OtherFirstName: | JERICHO | ||||||||
| OtherMiddleName: | MIKHAIL S | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RPT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10509 JAMAICA AVE STE C | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114182014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184413211 | ||||||||
| FaxNumber: | 7184413744 | ||||||||
| Practice Location | |||||||||
| Address1: | 10509 JAMAICA AVE STE C | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114182014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184413211 | ||||||||
| FaxNumber: | 7184413744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 039997-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.