Healthcare Provider Details

I. General information

NPI: 1447342944
Provider Name (Legal Business Name): OLABISI OLAJUYIN KUYE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BERGEN ST ACC LEVEL C
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

30 BERGEN ST ADMC 12 1205
NEWARK NJ
07107-3000
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-2700
  • Fax: 973-972-2739
Mailing address:
  • Phone: 973-972-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA07614700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: