Provider Demographics
NPI:1194113381
Name:OLORUNOJE, MORIAM (LPN, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:MORIAM
Middle Name:
Last Name:OLORUNOJE
Suffix:
Gender:F
Credentials:LPN, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 JERSEY ST
Mailing Address - Street 2:5H
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1464
Mailing Address - Country:US
Mailing Address - Phone:718-727-0612
Mailing Address - Fax:
Practice Address - Street 1:151 JERSEY ST
Practice Address - Street 2:5H
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1464
Practice Address - Country:US
Practice Address - Phone:718-727-0612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319817164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No164W00000XNursing Service ProvidersLicensed Practical Nurse