Provider Demographics
NPI:1528341609
Name:ODEYALE, OLUWAFEMI S (DPM)
Entity type:Individual
Prefix:DR
First Name:OLUWAFEMI
Middle Name:S
Last Name:ODEYALE
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:55 WATER STREET
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:12506 101ST AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419
Practice Address - Country:US
Practice Address - Phone:718-849-2900
Practice Address - Fax:718-559-5468
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006528213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN006528OtherLICENSE