Individual
ABIOLA OLAWALE FAMILUSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
820 E CENTER ST, BLANCHESTER, OH 45107-1310
(937) 783-4949
Mailing address
529 BEACH 20TH ST, FAR ROCKAWAY, NY 11691-3645
(718) 327-7307
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
196782
NY
208100000X
Physical Medicine & Rehabilitation Physician
196782
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01593017
—
NY
Enumeration date
10/18/2006
Last updated
10/01/2024
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