Individual
ABIDEMI OMOYEFA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1324 FOREST AVE STE 104, STATEN ISLAND, NY 10302-2044
(347) 791-9818
Mailing address
1324 FOREST AVE STE 104, STATEN ISLAND, NY 10302-2044
(347) 791-9818
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
510765
NY
Other
Enumeration date
05/08/2023
Last updated
05/08/2023
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