Healthcare Provider Details

I. General information

NPI: 1346101003
Provider Name (Legal Business Name): TENIOLA IDOWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 E 64TH ST
NEW YORK NY
10065-6704
US

IV. Provider business mailing address

20 WATERSIDE PLZ APT 30K
NEW YORK NY
10010-2616
US

V. Phone/Fax

Practice location:
  • Phone: 646-603-1354
  • 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: