Provider Demographics
NPI:1225315021
Name:OLANIYI, MUSTAPHA (LPN)
Entity Type:Individual
Prefix:MR
First Name:MUSTAPHA
Middle Name:
Last Name:OLANIYI
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E MOSHOLU PKWY S APT B5
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1747
Mailing Address - Country:US
Mailing Address - Phone:347-204-8058
Mailing Address - Fax:347-918-8627
Practice Address - Street 1:400 E MOSHOLU PKWY S APT B5
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1747
Practice Address - Country:US
Practice Address - Phone:347-204-8058
Practice Address - Fax:347-918-8627
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10283502164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse