Olutayo Olaide Olasupo, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

P128167 Issued in NY

Practice address

529 Beach 20TH St
Far Rockaway, NY 11691-3615

Phone

(718) 327-7307

Fax

(718) 327-3294

NPI assigned

Apr 17, 2025

Last updated

Apr 17, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Multiviz Medical Services PCGroup PAC ID 1557274735, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Multiviz Medical Services PC

  • Internal Medicine Physician
  • Far Rockaway, NY
  • NPI 1720373293

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Abiola Familusi

  dba Multiviz Health Services

  • Internal Medicine Physician
  • Far Rockaway, NY
  • NPI 1295958445

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1114713054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 BEACH 20TH ST",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116913615",
            "telephone_number": "718-327-7307",
            "fax_number": "718-327-3294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 BEACH 20TH ST",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116913615",
            "telephone_number": "718-327-7307",
            "fax_number": "718-327-3294"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "140 Saint Edwards St",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112013904",
            "country_code": "US",
            "telephone_number": "718-858-6400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLASUPO",
        "first_name": "OLUTAYO",
        "middle_name": "OLAIDE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-04-17",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "P128167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stella N Okafor, RN
• Valerie Okonkwo
• Joy Okoroh
• Titiayo Elizabeth Olabode
• Esther Olajide
• Olajide F Olawepo, M.D
• Samuel O Olawoyin, RN
• Maria Romina Gayeta Olimberio, PT
• Melissa Oliver, DOULA
• Patricia Ann Ollquist

• Internal Medicine Physician in Far Rockaway, NY
• Providers in Far Rockaway, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.