Healthcare Provider Details

I. General information

NPI: 1013239805
Provider Name (Legal Business Name): BANKOLE OGUNLEYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

46 LASALLE DR
NEW ROCHELLE NY
10801-4643
US

IV. Provider business mailing address

46 LASALLE DR
NEW ROCHELLE NY
10801-4643
US

V. Phone/Fax

Practice location:
  • Phone: 914-552-7213
  • Fax:
Mailing address:
  • Phone: 914-552-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number015951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: