Provider Demographics
NPI:1144572744
Name:OBAWEYA, OLUGBENGA
Entity Type:Individual
Prefix:
First Name:OLUGBENGA
Middle Name:
Last Name:OBAWEYA
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 1:333 E 92 STREET
Mailing Address - Street 2:6R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-1205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 E 92 STREET
Practice Address - Street 2:6R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1205
Practice Address - Country:US
Practice Address - Phone:347-709-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist