Healthcare Provider Details

I. General information

NPI: 1578149423
Provider Name (Legal Business Name): TEMITOPE OGUNDARE MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

720 HARRISON AVE
BOSTON MA
02118-2371
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-8075
  • Fax:
Mailing address:
  • Phone: 617-414-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1019214
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number337642-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: