Provider Demographics
NPI:1316764475
Name:ODIYOMA, AKPESIRI DAVID
Entity type:Individual
Prefix:
First Name:AKPESIRI
Middle Name:DAVID
Last Name:ODIYOMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2016
Mailing Address - Country:US
Mailing Address - Phone:908-887-5194
Mailing Address - Fax:
Practice Address - Street 1:432 S 7TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2016
Practice Address - Country:US
Practice Address - Phone:908-887-5194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJO18370156410842343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)