Provider Demographics
NPI:1083229538
Name:OSAWARU, FELIX IYINBOR
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:IYINBOR
Last Name:OSAWARU
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 1:375 BAY ROAD
Mailing Address - Street 2:ASSERTIVE COMMUNITY TREATMENT TEAM
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2614
Mailing Address - Country:US
Mailing Address - Phone:518-480-7870
Mailing Address - Fax:
Practice Address - Street 1:375 BAY ROAD
Practice Address - Street 2:ASSERTIVE COMMUNITY TREATMENT TEAM
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2614
Practice Address - Country:US
Practice Address - Phone:518-480-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403048363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health