Provider Demographics
NPI:1649445644
Name:OMORUYI, IVIE OYENMWEN (CNM)
Entity type:Individual
Prefix:
First Name:IVIE
Middle Name:OYENMWEN
Last Name:OMORUYI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:IVIE
Other - Middle Name:
Other - Last Name:IDEHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:271 DICKIE AVE # 1C
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3144
Mailing Address - Country:US
Mailing Address - Phone:718-913-0990
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:ROOM 221 KATZ
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-6278
Practice Address - Fax:718-240-8062
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001252176B00000X
NJ25ME00043401176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife