Healthcare Provider Details

I. General information

NPI: 1164315867
Provider Name (Legal Business Name): AO FAMILY HEALTH NP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BRYSON AVE
STATEN ISLAND NY
10314-1922
US

IV. Provider business mailing address

11 WALCOTT AVE
STATEN ISLAND NY
10314-6333
US

V. Phone/Fax

Practice location:
  • Phone: 718-581-8244
  • Fax: 844-689-3941
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ADEBUSOLA ONWUEMENE
Title or Position: PRESIDENT
Credential:
Phone: 718-581-8244