Healthcare Provider Details

I. General information

NPI: 1568528578
Provider Name (Legal Business Name): PHILIP OGUNLEYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W 34TH ST 11TH FLOOR
NEW YORK NY
10001-2320
US

IV. Provider business mailing address

46 LASALLE DR
NEW ROCHELLE NY
10801-4643
US

V. Phone/Fax

Practice location:
  • Phone: 212-273-6519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: