Active NPI
Olusegun Olatunbosun, PHYSICIAN ASSISTANT
- Physician Assistant
- Jamaica, NY
National Provider Identifier
1942478995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 012406
- Practice address
- 15601 N Conduit Ave
Apt. #C33
Jamaica, NY 11434-4300 - Phone
- (718) 755-1034
- NPI assigned
- Feb 12, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 012406 | NY | Primary |
Addresses
Primary practice location
15601 N Conduit Ave
Apt. #C33
Jamaica, NY 11434-4300
Mailing address
15601 N Conduit Ave
Apt. #C33
Jamaica, NY 11434-4300
Phone (718) 755-1034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012406 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202774400000",
"number": "1942478995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15601 N CONDUIT AVE",
"address_2": "APT. #C33",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114344300",
"telephone_number": "718-755-1034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15601 N CONDUIT AVE",
"address_2": "APT. #C33",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114344300",
"telephone_number": "718-755-1034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLATUNBOSUN",
"first_name": "OLUSEGUN",
"name_prefix": "Mr.",
"credential": "PHYSICIAN ASSISTANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-12",
"last_updated": "2008-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "012406",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.