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General NPI Number Information
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NPI Number | 1023275575
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Entity Type | Individual
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Provider Name | OMOLARA A OLANIYI PHD, FNP, RN
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Gender | Female
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 11156 76TH DR
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City | FOREST HILLS
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State | NY
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Zip | 11375-7057
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Country | US
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Telephone | 347-356-4434
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Fax | 718-544-0972
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Provider Business Mailing Address
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Address Line | 252 CORABELLE AVE
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City | LODI
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State | NJ
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Zip | 07644-1230
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Country | US
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Telephone | 347-356-4434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F333974-1
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License Number State | NY
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