MEDICARE: OLUSEYI ABATAN RN

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	163W00000X	Registered Nurse	637561	NY

General Provider Information

NPI Number	:	1548633704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUSEYI ABATAN RN

Provider Business Mailing Address
First Line	:	10736 164TH PL
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11433-2428
Country	:	US
Telephone Number	:	516-451-0911
Fax Number	:

Provider Business Practice Location Address
First Line	:	10736 164TH PL
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11433-2428
Country	:	US
Telephone Number	:	516-451-0911
Fax Number	:

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

Provider Enumeration Date	:	11/09/2015
Last Update Date	:	11/09/2015

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