Olutayo Olasupo, MD
NPI 1114713054 · Internal Medicine Physician · Far Rockaway, NY
Enrolled with Medicare as Practitioner - Internal Medicine · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Olutayo Olasupo, MD is a Internal Medicine Physician provider in Far Rockaway, NY (NPI 1114713054).
Provider details
- NPI number
- 1114713054
- Entity type
- Individual
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- Yes
- License
- P128167 (NY)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
1 yr in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Additional practice locations (1)
- 140 Saint Edwards StBrooklyn, NY 11201-3904Phone: (718) 858-6400
Registry dates
- Enumerated
- 2025-04-17
- Last updated
- 2025-04-17
- Certified
- 2025-04-12
Frequently asked questions
- What is Olutayo Olasupo's NPI number?
- Olutayo Olasupo's National Provider Identifier (NPI) is 1114713054, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Olutayo Olasupo's specialty?
- Olutayo Olasupo is listed in the NPPES registry with a primary specialty of Internal Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is Olutayo Olasupo located?
- Olutayo Olasupo's practice location on file with NPPES is 529 Beach 20th St, Far Rockaway, NY 11691-3615.
- What is Olutayo Olasupo's phone number?
- The practice phone number listed in the NPPES registry for Olutayo Olasupo is (718) 327-7307.
- Does Olutayo Olasupo accept Medicare?
- Olutayo Olasupo is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Is Olutayo Olasupo's NPI active?
- Yes — Olutayo Olasupo's NPI (1114713054) is active in the NPPES registry as of the last update on 2025-04-17.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.