Healthcare Provider Details

I. General information

NPI: 1417363847
Provider Name (Legal Business Name): GRACE OLUWATOYIN OKOLONJI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GRACE OLUWATOYIN OLANIYAN FNP

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9027 149TH ST APT G3
JAMAICA NY
11435-3958
US

IV. Provider business mailing address

9027 149TH ST APT G3
JAMAICA NY
11435-3958
US

V. Phone/Fax

Practice location:
  • Phone: 718-739-0605
  • Fax: 718-739-0605
Mailing address:
  • Phone: 718-739-0605
  • Fax: 718-739-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number338938
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: