Healthcare Provider Details

I. General information

NPI: 1689829517
Provider Name (Legal Business Name): ALICE O. OLOSUNDE MS, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICE O OLOSUNDE NP.

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PARKWAY CONEY ISLAND HOSPITAL DEPT. OF OBS/GYN
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

2601 OCEAN PARKWAY, CONEY ISLAND HOSPITAL DEPT. OF OBS/GYN
BROOKLYN NY
11235-7745
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-5728
  • Fax: 718-616-3260
Mailing address:
  • Phone: 718-616-5728
  • Fax: 718-616-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF360104
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000339
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: