Individual provider Active NPI

Oluwabukola Faba

  • Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1245644640
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
F309178-01 Issued in NY
Practice address
1 Brookdale PLZ
Brooklyn, NY 11212-3139
Phone
(917) 407-1383
NPI assigned
Jun 13, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 685259 NY
Nurse Practitioner 363L00000X F309178-01 NY Primary

Addresses

Primary practice location

1 Brookdale PLZ
Brooklyn, NY 11212-3139

Mailing address

77 Garnet PL
Elmont, NY 11003-3633
Phone (917) 407-1383

Other names 1

  • Bukola Faba Other name

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210127002967 NY Practitioner - Nurse Practitioner 0042624322 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
State University of New York at Stony Brook, School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Interfaith Professional Physician Services PCGroup PAC ID 9931378171, 383 clinicians

Practice addresses (Care Compare)

1545 Atlantic Ave
Brooklyn, NY 11213-1122
Phone (718) 613-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
685259NYMDRegistered Nurse
309178NYMDHospitalist Physician
F309178-01NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Urban Strategies Brookdale Family Care Center Inc CurrentSince Jul 7, 2021 Accepting new patients
Brookdale Hospital Medical Center CurrentSince Oct 6, 2021 Accepting new patients
Interfaith Emergency Medicine, P.C. Current Accepting new patients
Interfaith Professional Physician Services, P.C. CurrentSince Apr 1, 2024 Accepting new patients
The Brookdale Hospital Medical Center CurrentSince Oct 6, 2021 Accepting new patients

Locations

1545 Atlantic Ave
Brooklyn, NY 11213
Phone (718) 613-4175

2554 Linden Blvd
Brooklyn, NY 11208
Phone (718) 240-5132

1235 Linden Blvd
Fl 2
Brooklyn, NY 11212
Phone (718) 240-7143

465 New Lots Ave
Brooklyn, NY 11207
Phone (718) 240-5133

1873 Eastern Pkwy
Brooklyn, NY 11233
Phone (718) 240-5133

1 Brookdale Plz
Brooklyn, NY 11212
Phone (718) 240-5212

1235 Linden Blvd
Fl 1
Brooklyn, NY 11212
Phone (718) 975-8368

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Organizations & group practices 5

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

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1402617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1245644640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 GARNET PL",
            "city": "ELMONT",
            "state": "NY",
            "postal_code": "110033633",
            "telephone_number": "917-407-1383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BROOKDALE PLZ",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112123139",
            "telephone_number": "917-407-1383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FABA",
        "first_name": "OLUWABUKOLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-13",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "685259",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "F309178-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BUKOLA",
            "last_name": "FABA",
            "credential": "NURSE PRACTITIONER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.