Healthcare Provider Details

I. General information

NPI: 1316392632
Provider Name (Legal Business Name): MOROLAKE M OJO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOROLAKE REMI-JOHNSON M.D.

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BARD AVE DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR
STATEN ISLAND NY
10310-1664
US

IV. Provider business mailing address

355 BARD AVE DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR
STATEN ISLAND NY
10310-1664
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-2419
  • Fax:
Mailing address:
  • Phone: 718-818-2419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD468635
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number300445
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: