Healthcare Provider Details

I. General information

NPI: 1922635523
Provider Name (Legal Business Name): ELIZABETH OGUNSANYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKDALE PLZ
BROOKLYN NY
11212-3139
US

IV. Provider business mailing address

8 S EXETER ST
BALTIMORE MD
21202-4628
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-5000
  • Fax:
Mailing address:
  • Phone: 301-758-1390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number336151
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0102985
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberD0102985
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number336151
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0102985
License Number StateMD
# 6
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number336151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: