1871768929 NPI number — OLABISI OMOLARA ASIMOLOWO M.D.

Table of content: MOSHE LEVI MD (NPI 1396835971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871768929 NPI number — OLABISI OMOLARA ASIMOLOWO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASIMOLOWO
Provider First Name:
OLABISI
Provider Middle Name:
OMOLARA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871768929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9044
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARDONIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10954-9044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-838-7246
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORHAM PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07932-1049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-718-5800
Provider Business Practice Location Address Fax Number:
973-939-4216
Provider Enumeration Date:
04/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD446035 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: 25MA09630600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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