Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 071205 | NJ |
NPI | 1104830173 |
---|---|
Provider Name | Emilola Ogunbameru |
First Address | Newark, NJ 07101 |
Second Address | Paterson, NJ 07503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 03/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0054810 | (05) | NJ |
G37600 | (02) |