Provider Demographics
NPI:1548679061
Name:OJURONGBE, ABIMBOLA
Entity type:Individual
Prefix:MS
First Name:ABIMBOLA
Middle Name:
Last Name:OJURONGBE
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 1:2280 N OCEAN AVE
Mailing Address - Street 2:FARMINGVILLE KMART
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2911
Mailing Address - Country:US
Mailing Address - Phone:631-282-8450
Mailing Address - Fax:631-320-1300
Practice Address - Street 1:2280 N OCEAN AVE
Practice Address - Street 2:FARMINGVILLE KMART
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2911
Practice Address - Country:US
Practice Address - Phone:631-282-8450
Practice Address - Fax:631-320-1300
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337832-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily