Provider Demographics
NPI:1598133399
Name:FAMILY FIRST NURSE PRACTITIONER IN FAMILY HEALTH PC
Entity Type:Organization
Organization Name:FAMILY FIRST NURSE PRACTITIONER IN FAMILY HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMOLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLANIYI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:347-356-4434
Mailing Address - Street 1:11156 76TH DR STE UL1
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7029
Mailing Address - Country:US
Mailing Address - Phone:347-356-4434
Mailing Address - Fax:973-779-1696
Practice Address - Street 1:11156 76TH DR STE UL1
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7029
Practice Address - Country:US
Practice Address - Phone:347-356-4434
Practice Address - Fax:973-779-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333974-1261QP2300X
363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1023275575OtherHIPPA