1245332345 NPI number — DR. SUZETTE OLUBUSOLA OYEKU MD, MPH

Table of content: MARYANN TAVOLETTI PT (NPI 1588295596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245332345 NPI number — DR. SUZETTE OLUBUSOLA OYEKU MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OYEKU
Provider First Name:
SUZETTE
Provider Middle Name:
OLUBUSOLA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245332345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4901 HENRY HUDSON PKWY W
Provider Second Line Business Mailing Address:
APT 8G
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10471-3217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-796-3403
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3444 KOSSUTH AVE
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL AT MONTEFIORE/FAMILY CARE CENTER
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10467-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-920-6050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2006

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: 208000000X , with the licence number:  240819 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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