Provider Demographics
NPI:1043872955
Name:SOWEMIMO, OLAJIDE A
Entity Type:Individual
Prefix:
First Name:OLAJIDE
Middle Name:A
Last Name:SOWEMIMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BROADWAY,
Mailing Address - Street 2:DEPT OF PEDIATRICS, WOODHULL HOSPITAL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11206
Mailing Address - Country:US
Mailing Address - Phone:718-963-7956
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF PEDIATRICS, WOODHULL HOSPITAL,
Practice Address - Street 2:ROOM 6B23, 760 BROADWAY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-7957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program