Provider Demographics
NPI:1164933487
Name:O.B. ADULT HEALTH NURSE PRACTITIONER SERVICES PC
Entity Type:Organization
Organization Name:O.B. ADULT HEALTH NURSE PRACTITIONER SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLASUNKANMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BHADMUS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:917-374-9180
Mailing Address - Street 1:224 OSGOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:718-448-7263
Practice Address - Street 1:209 BROAD ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2105
Practice Address - Country:US
Practice Address - Phone:917-374-9180
Practice Address - Fax:718-448-7263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307489261Q00000X, 363LA2200X
NY573342364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontologyGroup - Multi-Specialty