1871112771 NPI number — MARY OLUWATOYIN OLUWATOBI PAUL MD

Table of content: MARY OLUWATOYIN OLUWATOBI PAUL MD (NPI 1871112771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871112771 NPI number — MARY OLUWATOYIN OLUWATOBI PAUL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAUL
Provider First Name:
MARY
Provider Middle Name:
OLUWATOYIN OLUWATOBI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAUL
Provider Other First Name:
OLUWATOBI
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871112771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
355 BARD AVENUE
Provider Second Line Business Mailing Address:
DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-818-2419
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 BARD AVENUE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-818-2419
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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