Healthcare Provider Details

I. General information

NPI: 1013543826
Provider Name (Legal Business Name): AKINBIYI AKINDUNBI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MARLBOROUGH AVE
MIDDLESEX NJ
08846-2020
US

IV. Provider business mailing address

14 MARLBOROUGH AVE
MIDDLESEX NJ
08846-2020
US

V. Phone/Fax

Practice location:
  • Phone: 862-215-2400
  • Fax:
Mailing address:
  • Phone: 862-215-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number679645-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: