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1578410346 NPI number — TOMILOLA WILSON ODUMUWAGUN PA-C

NPI Number: 1578410346
Health Care Provider/Practitioner: TOMILOLA WILSON ODUMUWAGUN PA-C

Information about “1578410346” NPI (TOMILOLA WILSON ODUMUWAGUN PA-C) exists in 1578410346 in HTML format HTML  |  1578410346 in plain Text format TXT  |  1578410346 in PDF (Portable Document Format) PDF  |  1578410346 in an XML format XML  formats.

NPI Number : 1578410346 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578410346",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ODUMUWAGUN",
    "FirstName": "TOMILOLA",
    "MiddleName": "WILSON",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "760 ELDERT LN APT 4J",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BROOKLYN",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11208-4234",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "917-216-9036",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12 N 7TH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MOUNT VERNON",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10550-2026",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "914-664-8000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/11/2026",
    "LastUpdateDate": "03/11/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "035083-01",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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