Provider Demographics
NPI:1790174464
Name:OWOLABI, ROTIMI TAOFIK (CNA/HHA)
Entity Type:Individual
Prefix:MR
First Name:ROTIMI
Middle Name:TAOFIK
Last Name:OWOLABI
Suffix:
Gender:M
Credentials:CNA/HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 BEACH CHANNEL DR # 3
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1917
Mailing Address - Country:US
Mailing Address - Phone:347-339-2750
Mailing Address - Fax:
Practice Address - Street 1:2543 BEACH CHANNEL DR # 3
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1917
Practice Address - Country:US
Practice Address - Phone:347-339-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00613392374700000X
NY343396010413E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374700000XNursing Service Related ProvidersTechnician