Healthcare Provider Details

I. General information

NPI: 1033250097
Provider Name (Legal Business Name): OLUFUNKE OGUNRINU MS, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E 57TH ST
BROOKLYN NY
11203-3709
US

IV. Provider business mailing address

35 E 57TH ST
BROOKLYN NY
11203-3709
US

V. Phone/Fax

Practice location:
  • Phone: 718-346-7062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number004167
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: