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General NPI Number Information
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NPI Number | 1760254221
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Entity Type | Individual
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Provider Name | ODIANOSEN ORIAIFO
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Gender | Male
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 12 TIBBITS AVE
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City | WHITE PLAINS
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State | NY
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Zip | 10606-2438
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Country | US
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Telephone | 914-287-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 57 BANK ST APT 1718
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City | WHITE PLAINS
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State | NY
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Zip | 10606-2069
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Country | US
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Telephone | 410-491-5396
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 032057
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License Number State | NY
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