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General NPI Number Information
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NPI Number | 1649692930
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Entity Type | Organization
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Legal Business Name | OLUWAFEMI ODEYALE PODIATRY PC
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 82 SAINT MARKS PL APT 1I
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City | STATEN ISLAND
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State | NY
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Zip | 10301-1644
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Country | US
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Telephone | 718-954-1744
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Fax |
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Provider Business Mailing Address
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Address Line | 82 SAINT MARKS PL APT 1I
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City | STATEN ISLAND
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State | NY
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Zip | 10301-1644
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Country | US
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Telephone | 718-954-1744
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. OLUWAFEMI S ODEYALE
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Credential | DPM
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Telephone | 718-954-1744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 006528
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License Number State | NY
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