Dr Omolola Omishore PT, P.C.

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

Legal business name

DR OMOLOLA OMISHORE PT, P.C.

Practice address

1138 Ocean Ave Apt 6I
Brooklyn, NY 11230

Phone

(917) 319-2245

NPI assigned

Oct 1, 2020

Last updated

Oct 1, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Omolola Omishore, DPTNPI 1366890089

Title

Physical Therapist

Phone

(917) 319-2245

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Omolola Omishore, PT,DPT,ATC

  • Physical Therapist
  • Quartz Hill, CA
  • NPI 1366890089

  NY

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1891392940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1138 OCEAN AVE APT 6I",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11230",
            "telephone_number": "917-319-2245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1138 OCEAN AVE APT 6I",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11230",
            "telephone_number": "917-319-2245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR OMOLOLA OMISHORE PT, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-01",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "OMISHORE",
        "authorized_official_first_name": "OMOLOLA",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "917-319-2245",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopedic Physical Therapist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Orthopedic Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.