Healthcare Provider Details

I. General information

NPI: 1477469021
Provider Name (Legal Business Name): ONAYEMI TITILAYO ONAGORUWA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: O. TITILAYO ONAGORUWA MD

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

IV. Provider business mailing address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-7107
  • Fax: 718-963-7719
Mailing address:
  • Phone: 718-963-7107
  • Fax: 718-963-7719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP143882
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: