MEDICARE: VICTOR OGUNDARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	618208	NY

General Provider Information

NPI Number	:	1497988653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR OGUNDARE

Provider Business Mailing Address
First Line	:	530 SAINT PAULS PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-2126
Country	:	US
Telephone Number	:	347-466-6024
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 SAINT PAULS PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-2126
Country	:	US
Telephone Number	:	347-466-6024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	09/03/2009

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Directions to “ VICTOR OGUNDARE ” Practice Location

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