Individual provider Active NPI

Rotimi Taofik Owolabi, CNA/HHA

  • Nurse's Aide
  • Far Rockaway, NY
National Provider Identifier
1790174464
Registry record updated Jan 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse's AideTaxonomy code 376K00000X
License
343396010413E Issued in NY
Practice address
2543 Beach Channel Dr # 3
Far Rockaway, NY 11691-1917
Phone
(347) 339-2750
NPI assigned
Jan 17, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 17, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Technician 374700000X 00613392 NY
Nurse's Aide 376K00000X 343396010413E NY Primary

Addresses

Primary practice location

2543 Beach Channel Dr # 3
Far Rockaway, NY 11691-1917

Mailing address

2543 Beach Channel Dr # 3
Far Rockaway, NY 11691-1917
Phone (347) 339-2750

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

LicenseStateTypeSpecialty
00613392NYMDTechnician
343396010413ENYMDNurse's Aide

NPI Registry JSON

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

{
    "created_epoch": "1421452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421452800000",
    "number": "1790174464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2543 BEACH CHANNEL DR # 3",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116911917",
            "telephone_number": "347-339-2750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2543 BEACH CHANNEL DR # 3",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116911917",
            "telephone_number": "347-339-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWOLABI",
        "first_name": "ROTIMI",
        "middle_name": "TAOFIK",
        "name_prefix": "Mr.",
        "credential": "CNA/HHA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-17",
        "last_updated": "2015-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374700000X",
            "taxonomy_group": "",
            "desc": "Technician",
            "state": "NY",
            "license": "00613392",
            "primary": false
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "NY",
            "license": "343396010413E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Far Rockaway, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2015; 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.