Provider Demographics
NPI:1922399567
Name:OBISANYA, JOSEPH K
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:K
Last Name:OBISANYA
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 1:69 BIRCH RD
Mailing Address - Street 2:#1
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1718
Mailing Address - Country:US
Mailing Address - Phone:718-619-5197
Mailing Address - Fax:
Practice Address - Street 1:69 BIRCH RD
Practice Address - Street 2:#1
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1718
Practice Address - Country:US
Practice Address - Phone:718-619-5197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-01
Last Update Date:2011-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304911-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse