Provider Demographics
NPI:1689996142
Name:EDOBOR-OSULA, OSAMUEDE FOLORUNSHO (MD)
Entity Type:Individual
Prefix:DR
First Name:OSAMUEDE
Middle Name:FOLORUNSHO
Last Name:EDOBOR-OSULA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:90 BERGEN ST
Mailing Address - Street 2:DOCTORS OFFICE CENTER, SUITE 7300
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2425
Mailing Address - Country:US
Mailing Address - Phone:973-972-2076
Mailing Address - Fax:973-972-1080
Practice Address - Street 1:90 BERGEN ST
Practice Address - Street 2:DOCTORS OFFICE CENTER, SUITE 7300
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-0244
Practice Address - Fax:973-972-1080
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2014-01-15
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09331900207XP3100X
NY250591207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery