Provider Demographics
NPI:1780985259
Name:AZEEZ, OLUFUNMILAY
Entity type:Individual
Prefix:
First Name:OLUFUNMILAY
Middle Name:
Last Name:AZEEZ
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 1:334 VAN CORTLANDT PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1438
Mailing Address - Country:US
Mailing Address - Phone:917-776-6360
Mailing Address - Fax:
Practice Address - Street 1:334 VAN CORTLANDT PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1438
Practice Address - Country:US
Practice Address - Phone:917-776-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300264-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse