Provider Demographics
NPI:1598918625
Name:OLASOKAN, COMFORT YEMI
Entity Type:Individual
Prefix:
First Name:COMFORT
Middle Name:YEMI
Last Name:OLASOKAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 BEACH 59TH ST
Mailing Address - Street 2:APT 4A
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1642
Mailing Address - Country:US
Mailing Address - Phone:718-337-3512
Mailing Address - Fax:
Practice Address - Street 1:324 BEACH 59TH ST
Practice Address - Street 2:APT 4A
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1642
Practice Address - Country:US
Practice Address - Phone:718-337-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY624163163W00000X
NY275068164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse