Provider Demographics
NPI:1093378853
Name:EGUNJOBI, FOLARIN O
Entity Type:Individual
Prefix:
First Name:FOLARIN
Middle Name:O
Last Name:EGUNJOBI
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 1:24 WEIR ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7608
Mailing Address - Country:US
Mailing Address - Phone:916-761-5549
Mailing Address - Fax:
Practice Address - Street 1:10030 DITMARS BLVD
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11369-1333
Practice Address - Country:US
Practice Address - Phone:646-294-8324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023534225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist