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General NPI Number Information
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NPI Number | 1376808915
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Entity Type | Individual
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Provider Name | GABRIEL OLUWASEGUN
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Gender | Male
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 11942 235TH ST
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City | CAMBRIA HEIGHTS
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State | NY
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Zip | 11411-2322
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Country | US
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Telephone | 347-548-5328
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Fax | 347-548-5328
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Provider Business Mailing Address
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Address Line | 11942 235TH ST
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City | CAMBRIA HEIGHTS
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State | NY
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Zip | 11411-2322
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Country | US
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Telephone | 347-548-5328
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Fax | 347-548-5328
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 085748
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License Number State | NY
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