Healthcare Provider Details

I. General information

NPI: 1922917913
Provider Name (Legal Business Name): MR. SOTONYE ORINAWENGIBO ORINAWENGIBO ATEMIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7439 N 21ST ST
PHILADELPHIA PA
19138-2208
US

IV. Provider business mailing address

7439 N 21ST ST
PHILADELPHIA PA
19138-2208
US

V. Phone/Fax

Practice location:
  • Phone: 601-907-3796
  • Fax:
Mailing address:
  • Phone: 601-907-3796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: