Doctor Name: | DR. OLUBUNMI ABIYE BOLAJI |
NPI Number: | 1619100633 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 254613 |
Business Practice Address: | 801 Gazzola Dr East Patchogue, NY - 117724900 |
Business Phone Number: | 6314478800 |
Business Fax Number: | |
Mailing Address: | 11 Bench Ln, LEVITTOWN |
State: | NY |
Postal Code: | 117561802 |
Phone Number: | 5164335813 |
Fax Number: | |
NPI Enumeration Date: | 08/25/2009 |
NPI Last Update Date: | 05/03/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 254613 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |