Provider Demographics
NPI:1770630337
Name:OYIBORHORO, JOHN MA (EDD, FAAA, FA)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MA
Last Name:OYIBORHORO
Suffix:
Gender:M
Credentials:EDD, FAAA, FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PROSPECT PARK SW
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1500
Mailing Address - Country:US
Mailing Address - Phone:718-622-3500
Mailing Address - Fax:718-622-1908
Practice Address - Street 1:207 PROSPECT PARK SW
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1500
Practice Address - Country:US
Practice Address - Phone:718-622-3500
Practice Address - Fax:718-622-1908
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00959231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01316449Medicaid
NY4500089OtherUNITED HEALTHCARE
NY165380OtherELDERPLAN
NY418986POtherHIP
NYKS723OtherOXFORD
NYM04331Medicare UPIN
NYKS723OtherOXFORD