Healthcare Provider Details

I. General information

NPI: 1548679061
Provider Name (Legal Business Name): MS. ABIMBOLA OJURONGBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 N OCEAN AVE FARMINGVILLE KMART
FARMINGVILLE NY
11738-2911
US

IV. Provider business mailing address

2280 N OCEAN AVE FARMINGVILLE KMART
FARMINGVILLE NY
11738-2911
US

V. Phone/Fax

Practice location:
  • Phone: 631-282-8450
  • Fax: 631-320-1300
Mailing address:
  • Phone: 631-282-8450
  • Fax: 631-320-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337832-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: