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General NPI Number Information
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NPI Number | 1184003121
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Entity Type | Individual
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Provider Name | ABIMBOLA ODUGUWA M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 6200 BEACH CHANNEL DR
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City | ARVERNE
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State | NY
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Zip | 11692-1409
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Country | US
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Telephone | 718-945-7150
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Fax |
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Provider Business Mailing Address
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Address Line | 550 W 54TH ST APT 1734
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City | NEW YORK
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State | NY
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Zip | 10019-4722
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 294088
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License Number State | NY
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