Provider Demographics
NPI:1861494239
Name:ESAN, OLANREWAJU OLUSOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLANREWAJU
Middle Name:OLUSOLA
Last Name:ESAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2041
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-0741
Mailing Address - Country:US
Mailing Address - Phone:516-485-5864
Mailing Address - Fax:516-485-0151
Practice Address - Street 1:320 WILSON ST
Practice Address - Street 2:STE 2
Practice Address - City:W HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2019
Practice Address - Country:US
Practice Address - Phone:516-485-5864
Practice Address - Fax:516-485-0151
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211598207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01862808Medicaid
92V371Medicare ID - Type Unspecified
G65307Medicare UPIN