| Empire Aco Llc | |
|
1545 Atlantic Ave Ste 108 Brooklyn NY 11213-1122 | |
| (347) 985-0804 | |
| Not Available |
| Full Name | Empire Aco Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1545 Atlantic Ave Ste 108, Brooklyn, New York |
| Authorized Official Name and Position | Abiola Familusi (COO) |
| Authorized Official Contact | 3479850804 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Empire Aco Llc 80 N Franklin St Hempstead NY 11550-3049 Ph: (347) 985-0804 | Empire Aco Llc 1545 Atlantic Ave Ste 108 Brooklyn NY 11213-1122 Ph: (347) 985-0804 |
| NPI Number | 1750879193 |
|---|---|
| Provider Enumeration Date | 04/30/2018 |
| Last Update Date | 04/30/2018 |
| Medicare PECOS PAC ID | 5496008575 |
|---|---|
| Medicare Enrollment ID | O20181019002513 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750879193 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Olusegun Ogunfowora |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275602963 PECOS PAC ID: 4789578535 Enrollment ID: I20040211001197 |
| Provider Name | Kolawole A Odulaja |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043384654 PECOS PAC ID: 7416935309 Enrollment ID: I20040708000430 |
| Provider Name | Abiola Familusi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649351214 PECOS PAC ID: 5890608079 Enrollment ID: I20041012000584 |
| Provider Name | Polina Khanina |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285679498 PECOS PAC ID: 0143280446 Enrollment ID: I20041012000729 |
| Provider Name | Adeola R Uthman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649204959 PECOS PAC ID: 4385794189 Enrollment ID: I20090617000441 |
| Provider Name | Neeraj Kumar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356594873 PECOS PAC ID: 3173716735 Enrollment ID: I20101015000449 |
| Provider Name | Margaret Amodemo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265527501 PECOS PAC ID: 3173700663 Enrollment ID: I20110609000660 |
| Provider Name | Theresa Clarke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497350383 PECOS PAC ID: 7517337371 Enrollment ID: I20230112001294 |
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