Provider Demographics
NPI:1316300726
Name:OLUSHOGA, OLUFUNKE G (MD)
Entity type:Individual
Prefix:DR
First Name:OLUFUNKE
Middle Name:G
Last Name:OLUSHOGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLUFUNKE
Other - Middle Name:G
Other - Last Name:ADEUSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4659
Mailing Address - Country:US
Mailing Address - Phone:201-656-5688
Mailing Address - Fax:
Practice Address - Street 1:108 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4659
Practice Address - Country:US
Practice Address - Phone:201-656-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11256500207R00000X
NY300504207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine