Healthcare Provider Details

I. General information

NPI: 1396031357
Provider Name (Legal Business Name): MRS. MORIRE OMOLARA AKINDUTIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 TOMPKINS AVENUE ST. ELIZABETH ANN'S HEALTH CARE
STATEN ISLAND NY
10304
US

IV. Provider business mailing address

34 BEACH STREET MARGARET ULTRA HOME CARE ,INC.
STATEN ISLAND NY
10304
US

V. Phone/Fax

Practice location:
  • Phone: 718-876-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number304588-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: