Individual
OMODUNNI OSOFISAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4422 3RD AVE, BRONX, NY 10457-2545
(718) 960-9000
Mailing address
4 SMITH LN, MIDDLE ISLAND, NY 11953-1851
(917) 495-2713
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P75658
NY
Other
Enumeration date
06/28/2013
Last updated
06/28/2013
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