Provider Demographics
NPI:1699060699
Name:TOSIN, OLUDARE J
Entity type:Individual
Prefix:
First Name:OLUDARE
Middle Name:J
Last Name:TOSIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MCKEEVER PL
Mailing Address - Street 2:APT. 15G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-2555
Mailing Address - Country:US
Mailing Address - Phone:718-953-5499
Mailing Address - Fax:
Practice Address - Street 1:47 MCKEEVER PL
Practice Address - Street 2:APT. 15G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-2555
Practice Address - Country:US
Practice Address - Phone:718-953-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305439164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse