Organization
EXODUS CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLANREWAJU SOMORIN M.D. (CEO)
(845) 837-1635
Entity
Organization
Contact information
Practice address
671 STATE ROUTE 17M, MONROE, NY 10950-3318
(845) 837-1635
(845) 837-1634
Mailing address
PO BOX 4124, MIDDLETOWN, NY 10941-8124
(845) 837-1635
(845) 837-1634
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
#2008-144
OASAS APPLICATION CERTIFICATION
NY
Enumeration date
07/27/2010
Last updated
07/27/2010
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