Provider Demographics
NPI:1679293195
Name:OGUNNIYI, OLAKANMI (CEO)
Entity Type:Individual
Prefix:
First Name:OLAKANMI
Middle Name:
Last Name:OGUNNIYI
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 DOUGHTY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5640
Mailing Address - Country:US
Mailing Address - Phone:609-286-9303
Mailing Address - Fax:609-286-9302
Practice Address - Street 1:1402 DOUGHTY RD STE 104
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5640
Practice Address - Country:US
Practice Address - Phone:609-286-9303
Practice Address - Fax:609-286-9302
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0323400251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health