MEDICARE: DR. OLANREWAJU OLUSOLA ESAN M.D.

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	211598	NY
2	207RP1001X	Pulmonary Disease Physician	211598	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	:	1861494239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLANREWAJU OLUSOLA ESAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2041
Second Line	:
City	:	WEST HEMPSTEAD
State	:	NY
Zip	:	11552-0741
Country	:	US
Telephone Number	:	516-485-5864
Fax Number	:	516-485-0151

Provider Business Practice Location Address
First Line	:	320 WILSON ST
Second Line	:	STE 2
City	:	W HEMPSTEAD
State	:	NY
Zip	:	11552-2019
Country	:	US
Telephone Number	:	516-485-5864
Fax Number	:	516-485-0151

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	05/25/2017

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