Provider Demographics
NPI:1124794763
Name:ODEKUNLE, FLORENCE FEMI
Entity type:Individual
Prefix:DR
First Name:FLORENCE
Middle Name:FEMI
Last Name:ODEKUNLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FLORENCE
Other - Middle Name:FEMI
Other - Last Name:OYEWOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:504 BEARDSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5607
Mailing Address - Country:US
Mailing Address - Phone:862-215-4021
Mailing Address - Fax:
Practice Address - Street 1:9131 175TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5517
Practice Address - Country:US
Practice Address - Phone:862-215-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP111358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine