Provider Demographics
NPI:1679029060
Name:OLORUNTOBA, NGOZI A (SPECIAL EDUCATION)
Entity Type:Individual
Prefix:
First Name:NGOZI
Middle Name:A
Last Name:OLORUNTOBA
Suffix:
Gender:F
Credentials:SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 BEACH 61ST ST
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1855
Mailing Address - Country:US
Mailing Address - Phone:917-402-5970
Mailing Address - Fax:
Practice Address - Street 1:157 BEACH 61ST ST
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1855
Practice Address - Country:US
Practice Address - Phone:917-402-5970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist