Olumide Damilola Akinmoju, M.D
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Newburgh, NY
NPI 1104679331 · NPPES record last updated Aug 2, 2024
Key facts
- NPI
- 1104679331
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 70 Dubois Street
Montefiore St. Luke'S Cornwall
Newburgh, NY 12550 - Phone
- (845) 561-4400
- Fax
- (845) 568-2614
- NPI assigned
- Apr 8, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260105001622 | MI | Order and Referring Only - Cardiovascular Disease (Cardiology) |
9638665185 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
70 Dubois Street
Montefiore St. Luke'S Cornwall
Newburgh, NY 12550
Mailing address
70 Dubois Street
Montefiore St. Luke'S Cornwall
Newburgh, NY 12550
Phone (845) 561-4400
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All providers in Newburgh, NY · Student in an Organized Health Care Education/Training Program in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.