Organization
FAMILY PEDIATRIC
Active
Other names
Family pediatric
Organization subpart
No
Provider details
NPI number
Authorized official
OLUWAKEMI OGUNDALU NURSE (REGISTERED NURSE)
(347) 683-0924
Entity
Organization
Contact information
Practice address
2224 COLLIER AVE, FAR ROCKAWAY, NY 11691-2637
(347) 683-0924
(516) 596-8860
Mailing address
2224 COLLIER AVE, FAR ROCKAWAY, NY 11691-2637
(347) 683-0924
(516) 596-8860
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
689977
NY
282NC2000X
Children's Hospital
Primary
689977
NY
302R00000X
Health Maintenance Organization
689977
NY
313M00000X
Nursing Facility/Intermediate Care Facility
689977
NY
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
689977
NY
Other
Enumeration date
01/14/2015
Last updated
01/14/2015
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