Individual
MR. TOBA OLUSHOLA OMIDIJI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
528 ROCKAWAY AVE, BROOKLYN, NY 11212-5625
(408) 762-1980
(408) 762-1980
Mailing address
528 ROCKAWAY AVE, BROOKLYN, NY 11212-5625
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
F307838
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F403703-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06073409
—
NY
Enumeration date
08/01/2017
Last updated
04/04/2022
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