Provider Demographics
NPI:1548969827
Name:OLORUNGBEMI, OLUFUNMILAYO RACHEL (MS CS)
Entity type:Individual
Prefix:
First Name:OLUFUNMILAYO
Middle Name:RACHEL
Last Name:OLORUNGBEMI
Suffix:
Gender:F
Credentials:MS CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-0193
Mailing Address - Country:US
Mailing Address - Phone:973-393-6306
Mailing Address - Fax:
Practice Address - Street 1:7 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1033
Practice Address - Country:US
Practice Address - Phone:973-393-6306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No156F00000XEye and Vision Services ProvidersTechnician/Technologist