Healthcare Provider Details

I. General information

NPI: 1508488057
Provider Name (Legal Business Name): ELIZABETH FEYIKEMI OGUNTUWASE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 EAST 68TH STREET
NEW YORK CITY NY
10065
US

IV. Provider business mailing address

424 EAST 70TH STREET
NEW YORK CITY NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-5454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: