Provider Demographics
NPI:1821774738
Name:OLUKITIBI CARE MEDICAL PRACTICE, PC
Entity Type:Organization
Organization Name:OLUKITIBI CARE MEDICAL PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:OLANREWAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUKITIBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-287-4401
Mailing Address - Street 1:79 ROUTE 59 STE 2
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4900
Mailing Address - Country:US
Mailing Address - Phone:404-287-4401
Mailing Address - Fax:
Practice Address - Street 1:79 ROUTE 59 STE 2
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4900
Practice Address - Country:US
Practice Address - Phone:404-287-4401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty