Provider Demographics
NPI:1255053849
Name:OBASUYI, LARRY J
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:J
Last Name:OBASUYI
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 1:7 BANES CT APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-1663
Mailing Address - Country:US
Mailing Address - Phone:646-671-0417
Mailing Address - Fax:
Practice Address - Street 1:7 BANES CT APT 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-1663
Practice Address - Country:US
Practice Address - Phone:646-671-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY818936163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse