MEDICARE: MR. CHARLES OSAKIDUWA OMOZUWA SR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	337790	NY

General Provider Information

NPI Number	:	1467316208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES OSAKIDUWA OMOZUWA SR.

Provider Business Mailing Address
First Line	:	436 BEACH 36TH ST APT 3
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-1507
Country	:	US
Telephone Number	:	347-972-1288
Fax Number	:

Provider Business Practice Location Address
First Line	:	436 BEACH 36TH ST APT 3
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-1507
Country	:	US
Telephone Number	:	347-972-1288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

Similar Medicare Providers

1689560807 — SSA WELLNESS LLC
Practice Location Address:

434 BEACH 36TH ST
FAR ROCKAWAY, NY
11691-1507

Practice Phone: 646-290-0142
Practice Fax:

1447115191 — RACHEL NISANOV
Practice Location Address:

1121 BAY 24TH ST
FAR ROCKAWAY, NY
11691-1745

Practice Phone: 718-600-6225
Practice Fax:

1972468379 — ATARA MALEK
Practice Location Address:

1214 HEYSON RD
FAR ROCKAWAY, NY
11691-5511

Practice Phone: 718-868-3232
Practice Fax:

1821953134 — SHAQUANNA KRISTAL PICTON
Practice Location Address:

322 BEACH 30TH ST APT 1
FAR ROCKAWAY, NY
11691-2011

Practice Phone: 929-757-2936
Practice Fax:

1447784806 — RAMY ELATTAL D.P.M
Practice Location Address:

327 BEACH 19TH ST
FAR ROCKAWAY, NY
11691-4423

Practice Phone: 212-410-8031
Practice Fax:

1992158125 — AFSANEH SHARSAN MD
Practice Location Address:

2035 SEAGIRT BLVD APT 5B
FAR ROCKAWAY, NY
11691-2938

Practice Phone: 949-973-0171
Practice Fax:

Directions to “ MR. CHARLES OSAKIDUWA OMOZUWA SR. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.