Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | R76156 | NY |
N | 222Z00000X | Podiatrist | R76156 | NY |
N | 213EP1101X | Primary Podiatric Medicine | R76156 | NY |
N | 2081S0010X | Sports Medicine | R76156 | NY |
N | 213ES0000X | Sports Medicine | R76156 | NY |
Y | 213ES0103X | Foot & Ankle Surgery | R76156 | NY |
NPI | 1306129341 |
---|---|
Provider Name | Dr. Olatunde Osofisan |
First Address | Brooklyn, NY 11206-7121 |
Second Address | Brooklyn, NY 11213-1122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2011 |
Last Update Date | 26/09/2011 |