Individual
SAMUEL OBISANYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
69 BIRCH RD APT 1, STATEN ISLAND, NY 10303-1718
(347) 994-6911
Mailing address
69 BIRCH RD APT 1, STATEN ISLAND, NY 10303-1718
(347) 994-6911
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
310996
NY
Other
Enumeration date
04/15/2016
Last updated
04/15/2016
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