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General NPI Number Information
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NPI Number | 1821774738
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Entity Type | Organization
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Legal Business Name | OLUKITIBI CARE MEDICAL PRACTICE, PC
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 79 ROUTE 59 STE 2
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City | SUFFERN
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State | NY
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Zip | 10901-4900
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Country | US
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Telephone | 404-287-4401
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Fax |
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Provider Business Mailing Address
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Address Line | 79 ROUTE 59 STE 2
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City | SUFFERN
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State | NY
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Zip | 10901-4900
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Country | US
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Telephone | 404-287-4401
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MR. OLANREWAJU OLUKITIBI
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Credential |
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Telephone | 404-287-4401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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