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General NPI Number Information
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NPI Number | 1023791928
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Entity Type | Organization
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Legal Business Name | EXEDUS FAMILY HEALTHCARE & WELLNESS CARE SERVICES LLC
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 11410 MERRICK BLVD
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City | JAMAICA
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State | NY
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Zip | 11434-1335
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Country | US
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Telephone | 718-233-2972
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Fax | 667-771-0892
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Provider Business Mailing Address
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Address Line | 1 WINTER LN
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City | AMITYVILLE
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State | NY
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Zip | 11701-1626
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Country | US
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Telephone | 917-653-0577
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Fax | 667-771-0892
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Authorized Official
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Title or Position | CEO
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Name | DR. OMOTUNDE D ADERIN
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Credential | DNP, APRN
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Telephone | 718-233-2972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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