Healthcare Provider Details

I. General information

NPI: 1487914107
Provider Name (Legal Business Name): BADEJOKO A OGUNSANYA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 EAST 179 STREET
BRONX NY
10457-5006
US

IV. Provider business mailing address

700 E 179TH ST
BRONX NY
10457-5006
US

V. Phone/Fax

Practice location:
  • Phone: 718-583-3823
  • Fax:
Mailing address:
  • Phone: 718-583-3823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number163WS0200X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: