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General NPI Number Information
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NPI Number | 1578182333
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Entity Type | Individual
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Provider Name | OLUWAROTIMI ABORISADE
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Gender | Male
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 11917 202ND ST
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3815
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Country | US
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Telephone | 347-567-6635
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Fax |
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Provider Business Mailing Address
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Address Line | 11917 202ND ST
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3815
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Country | US
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Telephone | 347-567-6635
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR25007100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ15447700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 407831
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 743164
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License Number State | NY
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