Provider Demographics
NPI:1578534749
Name:WEST ORANGE NEPHROLOGY LLC
Entity Type:Organization
Organization Name:WEST ORANGE NEPHROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BANJI
Authorized Official - Middle Name:
Authorized Official - Last Name:AWOSIKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-297-8408
Mailing Address - Street 1:301 S WEST CROWN POINT RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2916
Mailing Address - Country:US
Mailing Address - Phone:407-297-8408
Mailing Address - Fax:407-297-8409
Practice Address - Street 1:1210 E PLANT ST STE 120
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2995
Practice Address - Country:US
Practice Address - Phone:407-297-8408
Practice Address - Fax:407-297-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90977174400000X
207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005563100Medicaid
FLH38152Medicare UPIN
FL005563100Medicaid