Provider Demographics
NPI:1851545735
Name:OWOEYE, AYOBAMI GBEMIGA
Entity Type:Individual
Prefix:MR
First Name:AYOBAMI
Middle Name:GBEMIGA
Last Name:OWOEYE
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 1:1471 SAINT MARKS AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-4606
Mailing Address - Country:US
Mailing Address - Phone:917-600-1888
Mailing Address - Fax:
Practice Address - Street 1:1471 SAINT MARKS AVE
Practice Address - Street 2:APT 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-4606
Practice Address - Country:US
Practice Address - Phone:917-600-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282933164W00000X
NY639520-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse