Provider Demographics
NPI:1174301055
Name:ENITAN HEALTHCARE SERVICES
Entity type:Organization
Organization Name:ENITAN HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLUWATOBI
Authorized Official - Middle Name:FATIMA
Authorized Official - Last Name:OGUNRINDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-444-5544
Mailing Address - Street 1:9507 LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4919
Mailing Address - Country:US
Mailing Address - Phone:240-273-1224
Mailing Address - Fax:
Practice Address - Street 1:9507 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4919
Practice Address - Country:US
Practice Address - Phone:240-273-1224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical Laboratory