MEDICARE: OLADAYO OYEDELE JUDD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	2291758	MA
2	363L00000X	Nurse Practitioner	431078	NY

General Provider Information

NPI Number	:	1578928180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLADAYO OYEDELE JUDD

Provider Business Mailing Address
First Line	:	321 W 24TH ST APT 9A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-1551
Country	:	US
Telephone Number	:	617-512-2099
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 WEST KINGSBRIDGE ROAD
Second Line	:	REHAB MEDICINE
City	:	BRONX
State	:	NY
Zip	:	10468-1046
Country	:	US
Telephone Number	:	718-584-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2015
Last Update Date	:	11/06/2020

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