Healthcare Provider Details

I. General information

NPI: 1154715431
Provider Name (Legal Business Name): ANGELA OGUNSUYI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GEORGETOWN DR
MANALAPAN NJ
07726-3606
US

IV. Provider business mailing address

10 GEORGETOWN DR
MANALAPAN NJ
07726-3606
US

V. Phone/Fax

Practice location:
  • Phone: 732-216-7003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number058856
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: