Provider Demographics
NPI:1649424359
Name:OKPESEYI, OMORODION
Entity Type:Individual
Prefix:
First Name:OMORODION
Middle Name:
Last Name:OKPESEYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18933 117TH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3357
Mailing Address - Country:US
Mailing Address - Phone:347-896-7259
Mailing Address - Fax:
Practice Address - Street 1:18933 117TH RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3357
Practice Address - Country:US
Practice Address - Phone:347-896-7259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY550860163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse