Provider Demographics
NPI:1689829517
Name:OLOSUNDE, ALICE O (MS, CNM)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:O
Last Name:OLOSUNDE
Suffix:
Gender:F
Credentials:MS, CNM
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:O
Other - Last Name:OLOSUNDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2601 OCEAN PARKWAY, CONEY ISLAND HOSPITAL
Mailing Address - Street 2:DEPT. OF OBS/GYN
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7745
Mailing Address - Country:US
Mailing Address - Phone:718-616-5728
Mailing Address - Fax:718-616-3260
Practice Address - Street 1:2601 OCEAN PARKWAY CONEY ISLAND HOSPITAL
Practice Address - Street 2:DEPT. OF OBS/GYN
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7745
Practice Address - Country:US
Practice Address - Phone:718-616-5728
Practice Address - Fax:718-616-3260
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF360104363L00000X
NYF000339367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMO00218520OtherDEA #