| Exodushealth Medical, Pc | |
|
1200 State Route 208 Monroe NY 10950-4648 | |
| (845) 837-1635 | |
| (845) 231-6078 |
| Full Name | Exodushealth Medical, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 1200 State Route 208, Monroe, New York |
| Authorized Official Name and Position | Olanrewaju Somorin (OWNER) |
| Authorized Official Contact | 8452942595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Exodushealth Medical, Pc 420 E Main St Middletown NY 10940-2516 Ph: (845) 294-2595 | Exodushealth Medical, Pc 1200 State Route 208 Monroe NY 10950-4648 Ph: (845) 837-1635 |
| NPI Number | 1083883458 |
|---|---|
| Provider Enumeration Date | 02/29/2008 |
| Last Update Date | 04/19/2024 |
| Certification Date | 04/19/2024 |
| Medicare PECOS PAC ID | 1456625078 |
|---|---|
| Medicare Enrollment ID | O20170920004011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083883458 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 212042 (New York) | Primary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
| Provider Name | Olanrewaju Somorin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679661979 PECOS PAC ID: 1557324852 Enrollment ID: I20041108000914 |
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