MEDICARE: OPTIMUM FAMILY MEDICINE P.C

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	261Q00000X	Clinic/Center	236764	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609952043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM FAMILY MEDICINE P.C

Provider Business Mailing Address
First Line	:	675 NEREID AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10470-1514
Country	:	US
Telephone Number	:	347-202-9545
Fax Number	:	347-202-9580

Provider Business Practice Location Address
First Line	:	675 NEREID AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10470-1514
Country	:	US
Telephone Number	:	347-202-9545
Fax Number	:	347-202-9580

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. OLUFUNMILAYO O ADEYANJU
Credential	:	M.D
Telephone Number	:	347-202-9545

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	08/22/2020

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