Healthcare Provider Details

I. General information

NPI: 1083217962
Provider Name (Legal Business Name): OLAPEJU OYEYEMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 N PLANK RD STE 10
NEWBURGH NY
12550-2111
US

IV. Provider business mailing address

17 N PLANK RD STE 10
NEWBURGH NY
12550-2111
US

V. Phone/Fax

Practice location:
  • Phone: 845-800-9305
  • Fax: 844-800-1470
Mailing address:
  • Phone: 845-800-9305
  • Fax: 844-800-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number098575
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: