Healthcare Provider Details

I. General information

NPI: 1962703611
Provider Name (Legal Business Name): OLUFEMI O OGUNJANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ROE AVE
ELMIRA NY
14905-1629
US

IV. Provider business mailing address

722 W WATER ST
ELMIRA NY
14905-2435
US

V. Phone/Fax

Practice location:
  • Phone: 607-737-7770
  • Fax: 607-271-3686
Mailing address:
  • Phone: 607-271-2060
  • Fax: 607-271-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number258630
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: