Healthcare Provider Details

I. General information

NPI: 1184209058
Provider Name (Legal Business Name): GABRIEL O AKINYEMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13621 HILLSIDE AVE STE M11
RICHMOND HILL NY
11418-1962
US

IV. Provider business mailing address

14020 BASCOM AVE
JAMAICA NY
11436-1713
US

V. Phone/Fax

Practice location:
  • Phone: 929-415-9781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346965
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: