Basic Information
| Provider Information | |||||||||
| NPI: | 1689829517 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLOSUNDE | ||||||||
| FirstName: | ALICE | ||||||||
| MiddleName: | O. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MS, CNM | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OLOSUNDE | ||||||||
| OtherFirstName: | ALICE | ||||||||
| OtherMiddleName: | O | ||||||||
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| OtherCredential: | NP. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2601 OCEAN PARKWAY, CONEY ISLAND HOSPITAL | ||||||||
| Address2: | DEPT. OF OBS/GYN | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112357745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186165728 | ||||||||
| FaxNumber: | 7186163260 | ||||||||
| Practice Location | |||||||||
| Address1: | 2601 OCEAN PARKWAY CONEY ISLAND HOSPITAL | ||||||||
| Address2: | DEPT. OF OBS/GYN | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112357745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186165728 | ||||||||
| FaxNumber: | 7186163260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2008 | ||||||||
| LastUpdateDate: | 11/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F360104 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367A00000X | F000339 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | MO00218520 | 01 | NY | DEA # | OTHER |