Healthcare Provider Details

I. General information

NPI: 1861911778
Provider Name (Legal Business Name): OGUNLEYE REHABILITATION SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 LASALLE DRIVE
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: 914-837-4196
  • Fax: 914-740-5633
Mailing address:
  • Phone: 914-837-4196
  • Fax: 914-740-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number006982-1
License Number StateNY

VIII. Authorized Official

Name: DR. PHILIP OGUNLEYE
Title or Position: PRESIDENT
Credential: PHD, OTR/L
Phone: 914-837-4196