Provider Demographics
NPI:1770320954
Name:BAMGBOSHE, OLUWATOSIN
Entity type:Individual
Prefix:MISS
First Name:OLUWATOSIN
Middle Name:
Last Name:BAMGBOSHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ACADEMY ST STE 303
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2900
Mailing Address - Country:US
Mailing Address - Phone:973-878-3900
Mailing Address - Fax:973-878-3809
Practice Address - Street 1:45 ACADEMY ST STE 303
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2900
Practice Address - Country:US
Practice Address - Phone:973-878-3900
Practice Address - Fax:973-878-3809
Is Sole Proprietor?:No
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator