Healthcare Provider Details

I. General information

NPI: 1851089098
Provider Name (Legal Business Name): OLUBIMPE RUTH FREEMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 VANDERBILT AVE
STATEN ISLAND NY
10304-2605
US

IV. Provider business mailing address

16 VANDERBILT AVE
STATEN ISLAND NY
10304-2605
US

V. Phone/Fax

Practice location:
  • Phone: 347-682-9704
  • Fax:
Mailing address:
  • Phone: 347-682-9704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408441
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: