Provider Demographics
NPI:1871714519
Name:OLUBIYI, EMMANUEL O (PA)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:O
Last Name:OLUBIYI
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1484 INWOOD AVE
Mailing Address - Street 2:APT. 3-C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-2234
Mailing Address - Country:US
Mailing Address - Phone:718-731-5495
Mailing Address - Fax:
Practice Address - Street 1:500 W 180TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-5905
Practice Address - Country:US
Practice Address - Phone:212-543-2277
Practice Address - Fax:212-543-2219
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY011326-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant