MEDICARE: MR. AYOBAMI GBEMIGA OWOEYE

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	164W00000X	Licensed Practical Nurse	282933	NY
2	163W00000X	Registered Nurse	639520-1	NY

General Provider Information

NPI Number	:	1851545735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AYOBAMI GBEMIGA OWOEYE

Provider Business Mailing Address
First Line	:	1471 SAINT MARKS AVE
Second Line	:	APT 3
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4606
Country	:	US
Telephone Number	:	917-600-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1471 SAINT MARKS AVE
Second Line	:	APT 3
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4606
Country	:	US
Telephone Number	:	917-600-1888
Fax Number	:

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

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	01/17/2012

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