=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063381747
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH WELLNESS MEDICAL ASTORIA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3274 STEINWAY ST
-----------------------------------------------------
City | ASTORIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11103-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-355-1328
-----------------------------------------------------
Fax | 332-296-8382
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3274 STEINWAY ST
-----------------------------------------------------
City | ASTORIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11103-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-355-1328
-----------------------------------------------------
Fax | 332-296-8382
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. OLUTIMILEHIN OLUTOMIWA OYENIRAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 908-344-8963
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207QS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------