Provider Demographics
NPI:1417363847
Name:OKOLONJI, GRACE OLUWATOYIN
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:OLUWATOYIN
Last Name:OKOLONJI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GRACE
Other - Middle Name:OLUWATOYIN
Other - Last Name:OLANIYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:9027 149TH ST
Mailing Address - Street 2:APT G3
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3958
Mailing Address - Country:US
Mailing Address - Phone:718-739-0605
Mailing Address - Fax:718-739-0605
Practice Address - Street 1:9027 149TH ST
Practice Address - Street 2:APT G3
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3958
Practice Address - Country:US
Practice Address - Phone:718-739-0605
Practice Address - Fax:718-739-0605
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338938281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital