MEDICARE: MR. MUSTAPHA OLANIYI LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	10283502	NY

General Provider Information

NPI Number	:	1225315021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MUSTAPHA OLANIYI LPN

Provider Business Mailing Address
First Line	:	400 E MOSHOLU PKWY S APT B5
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1747
Country	:	US
Telephone Number	:	347-204-8058
Fax Number	:	347-918-8627

Provider Business Practice Location Address
First Line	:	400 E MOSHOLU PKWY S APT B5
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1747
Country	:	US
Telephone Number	:	347-204-8058
Fax Number	:	347-918-8627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2011
Last Update Date	:	11/08/2011

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