Provider Demographics
NPI:1871473827
Name:JOHN-OMOTOSHO, EKAETE
Entity type:Individual
Prefix:
First Name:EKAETE
Middle Name:
Last Name:JOHN-OMOTOSHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 CARLTON AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-2107
Mailing Address - Country:US
Mailing Address - Phone:347-756-2694
Mailing Address - Fax:347-756-2694
Practice Address - Street 1:3030 47TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3433
Practice Address - Country:US
Practice Address - Phone:973-658-3398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY840114163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse