Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Olutayo Olaide Olasupo, MD

Individual provider Internal Medicine Physician · NPI 1114713054

Dr. Olutayo Olaide Olasupo, MD is an Internal Medicine in Far Rockaway, New York. Qualified in 2006, 20 years ago. Practices with Multiviz Medical Services PC, a 27-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in New York.

Years since qualifying
20
Licensed in
NY
In the registry since
2025
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

529 Beach 20th St
Far Rockaway, NY 11691-3615
Phone: (718) 327-7307
Fax: (718) 327-3294
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 140 Saint Edwards St, Brooklyn, NY 11201-3904 — (718) 858-6400

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence P128167 (NY)

Record details

NPI number1114713054
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedApril 17, 2025
Last updated in NPPESApril 17, 2025
Certification dateApril 12, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Multiviz Medical Services Pc — 27 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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