Healthcare Provider Details

I. General information

NPI: 1063434447
Provider Name (Legal Business Name): PAULINE A WALKS-AKINTOBI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 BROADWAY
NEWARK NJ
07104-4309
US

IV. Provider business mailing address

1413 FULTON ST
BROOKLYN NY
11216-2607
US

V. Phone/Fax

Practice location:
  • Phone: 973-483-1300
  • Fax: 973-676-1396
Mailing address:
  • Phone: 718-636-4500
  • Fax: 718-636-2998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberAW2478091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: