MEDICARE: NNAMDI OLISAH

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	225100000X	Physical Therapist	055568	NY

General Provider Information

NPI Number	:	1710820964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NNAMDI OLISAH

Provider Business Mailing Address
First Line	:	217 E 7TH ST APT 6C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-2631
Country	:	US
Telephone Number	:	718-578-3046
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-6591
Country	:	US
Telephone Number	:	718-874-9322
Fax Number	:	718-874-9323

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “ NNAMDI OLISAH ” Practice Location

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