Provider Demographics
NPI:1609952043
Name:OPTIMUM FAMILY MEDICINE P.C
Entity Type:Organization
Organization Name:OPTIMUM FAMILY MEDICINE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUFUNMILAYO
Authorized Official - Middle Name:O
Authorized Official - Last Name:ADEYANJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-202-9545
Mailing Address - Street 1:675 NEREID AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1514
Mailing Address - Country:US
Mailing Address - Phone:347-202-9545
Mailing Address - Fax:347-202-9580
Practice Address - Street 1:675 NEREID AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1514
Practice Address - Country:US
Practice Address - Phone:347-202-9545
Practice Address - Fax:347-202-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236764261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02797726Medicaid