Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 238193 | NY |
NPI | 1356415970 |
---|---|
Provider Name | Dr. Taiye O Odedosu |
First Address | New York, NY 10128-4007 |
Second Address | New York, NY 10016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
251296 | MDID (01) | NY |