Provider Demographics
NPI:1457627630
Name:OGUNJEMILUSI, OLUWATOSIN ADEMOLA (MD-MAY 10, 2012)
Entity Type:Individual
Prefix:DR
First Name:OLUWATOSIN
Middle Name:ADEMOLA
Last Name:OGUNJEMILUSI
Suffix:
Gender:M
Credentials:MD-MAY 10, 2012
Other - Prefix:DR
Other - First Name:TOSIN
Other - Middle Name:ADEMOLA
Other - Last Name:JEMILUSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:50 E 98TH ST
Mailing Address - Street 2:APT 4I-1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6552
Mailing Address - Country:US
Mailing Address - Phone:646-301-5738
Mailing Address - Fax:
Practice Address - Street 1:50 E 98TH ST
Practice Address - Street 2:APT 4I-1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6552
Practice Address - Country:US
Practice Address - Phone:646-301-5738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-01
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2032026390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program