Provider Demographics
NPI:1174834527
Name:OJOMO-JOSEPH, ADETUTU
Entity Type:Individual
Prefix:
First Name:ADETUTU
Middle Name:
Last Name:OJOMO-JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2470
Mailing Address - Country:US
Mailing Address - Phone:347-968-2443
Mailing Address - Fax:
Practice Address - Street 1:347 UNION AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2470
Practice Address - Country:US
Practice Address - Phone:347-968-2443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5584901163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool