NPIMap

Organization Active NPI

Exodus Clinic LLC

  • Clinic/Center
  • Monroe, NY
National Provider Identifier
1689988149
Registry record updated Jul 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
EXODUS CLINIC LLC
Practice address
671 State Route 17M
Monroe, NY 10950-3318
Phone
(845) 837-1635
Fax
(845) 837-1634
NPI assigned
Jul 27, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2010

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

Authorized official

Name
Dr. Olanrewaju Somorin, M.D.
Title
Ceo
Phone
(845) 837-1635

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NY Primary

Addresses

Primary practice location

671 State Route 17M
Monroe, NY 10950-3318

Mailing address

PO Box 4124
Middletown, NY 10941-8124
Phone (845) 837-1635

Other identifiers 1

IdentifierTypeStateIssuer
#2008-144OtherNYOASAS APPLICATION CERTIFICATION

National Provider Directory

National Provider Directory
Tax ID family
Exodus Clinic LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

671 State Route 17M
Monroe, NY 10950
Phone (845) 837-1635

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1280188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280188800000",
    "number": "1689988149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4124",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109418124",
            "telephone_number": "845-837-1635",
            "fax_number": "845-837-1634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "671 STATE ROUTE 17M",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109503318",
            "telephone_number": "845-837-1635",
            "fax_number": "845-837-1634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXODUS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-27",
        "last_updated": "2010-07-27",
        "status": "A",
        "authorized_official_last_name": "SOMORIN",
        "authorized_official_first_name": "OLANREWAJU",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "845-837-1635",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OASAS APPLICATION CERTIFICATION",
            "identifier": "#2008-144",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.