Active NPI
Omodunni Osofisan
- Podiatrist
- Bronx, NY
National Provider Identifier
1356781801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- P75658
- Practice address
- 4422 3Rd Ave
Bronx, NY 10457-2545 - Phone
- (718) 960-9000
- NPI assigned
- Jun 28, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | P75658 | NY | Primary |
Addresses
Primary practice location
4422 3Rd Ave
Bronx, NY 10457-2545
Mailing address
4 Smith LN
Middle Island, NY 11953-1851
Phone (917) 495-2713
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P75658 | NY | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372377600000",
"number": "1356781801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 SMITH LN",
"city": "MIDDLE ISLAND",
"state": "NY",
"postal_code": "119531851",
"telephone_number": "917-495-2713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4422 3RD AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104572545",
"telephone_number": "718-960-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OSOFISAN",
"first_name": "OMODUNNI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-28",
"last_updated": "2013-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "NY",
"license": "P75658",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.