Healthcare Provider Details

I. General information

NPI: 1295230134
Provider Name (Legal Business Name): OLUFUNMILAYO C. A ELEANYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLUFUNMILAYO CATHERINE AGUNLOYE MD

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 FRANKLIN AVE
GARDEN CITY NY
11530-1617
US

IV. Provider business mailing address

700 HICKSVILLE RD STE 205
BETHPAGE NY
11714-3472
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-1145
  • Fax: 929-455-9927
Mailing address:
  • Phone: 646-501-3229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number327684
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: