Provider Demographics
NPI:1265879027
Name:OLUSOJI, ABIMBOLA TAWAKALITU (MSC SPECIAL ED)
Entity type:Individual
Prefix:MRS
First Name:ABIMBOLA
Middle Name:TAWAKALITU
Last Name:OLUSOJI
Suffix:
Gender:F
Credentials:MSC SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 PROSPECT AVE APT 501
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3981
Mailing Address - Country:US
Mailing Address - Phone:347-458-3664
Mailing Address - Fax:
Practice Address - Street 1:890 PROSPECT AVE APT 501
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3981
Practice Address - Country:US
Practice Address - Phone:347-458-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730283131174400000X
NY734917131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist