Healthcare Provider Details

I. General information

NPI: 1275771495
Provider Name (Legal Business Name): MARTHA OGUNJANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N 5TH AVE APT 17
MOUNT VERNON NY
10550-1245
US

IV. Provider business mailing address

137 N 5TH AVE APT 17
MOUNT VERNON NY
10550-1245
US

V. Phone/Fax

Practice location:
  • Phone: 914-371-7311
  • Fax:
Mailing address:
  • Phone: 914-371-7311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number191322
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: