Provider Demographics
NPI:1346274206
Name:EPIGNOSIS SPECIALTY PRACTICE P.C.
Entity Type:Organization
Organization Name:EPIGNOSIS SPECIALTY PRACTICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:OLANREWAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:ESAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-485-5864
Mailing Address - Street 1:320 WILSON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2019
Mailing Address - Country:US
Mailing Address - Phone:516-485-5864
Mailing Address - Fax:516-485-0151
Practice Address - Street 1:320 WILSON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2019
Practice Address - Country:US
Practice Address - Phone:516-485-5864
Practice Address - Fax:516-485-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211598305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service