Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP0504X | Public Medicine | 006322 | NY |
N | 213EP1101X | Primary Podiatric Medicine | 006322 | NY |
N | 111NR0200X | Radiology | 006322 | NY |
N | 213ER0200X | Radiology | 006322 | NY |
Y | 213ES0103X | Foot & Ankle Surgery | 006322 | NY |
NPI | 1801023239 |
---|---|
Provider Name | Dr. Olutunde Aina Shoniregun |
First Address | Brooklyn, NY 11236-5102 |
Second Address | Bronx, NY 10455-4013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2009 |
Last Update Date | 06/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03186165 | (05) | NY |
1720318652 | MEDICARE GROUP NPI (01) | NY |
270613712 | FEDERAL TAX ID# (01) |