Basic Information
| Provider Information | |||||||||
| NPI: | 1912427410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLAGUNJU | ||||||||
| FirstName: | AISHAT | ||||||||
| MiddleName: | OMOYENI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4422 3RD AVE DEPT OF | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104572545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189606202 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4422 3RD AVENUE | ||||||||
| Address2: | ST BARNABAS HOSPITAL | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104684709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8324176927 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2017 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | MD2019-1104 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.