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NPI Code Detail

MEDICARE: ODIANOSEN ORIAIFO

MEDICARE: ODIANOSEN ORIAIFO
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
1363A00000XPhysician Assistant032057NY

General Provider Information

NPI Number : 1760254221
Entity Type Code : Individual
Provider Name (Legal Business Name) : ODIANOSEN ORIAIFO
Provider Business Mailing Address
First Line : 57 BANK ST APT 1718
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10606-2069
Country : US
Telephone Number : 410-491-5396
Fax Number :
Provider Business Practice Location Address
First Line : 12 TIBBITS AVE
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10606-2438
Country : US
Telephone Number : 914-287-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2023
Last Update Date : 03/18/2025

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Directions to “ ODIANOSEN ORIAIFO ” Practice Location

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