Healthcare Provider Details

I. General information

NPI: 1497271258
Provider Name (Legal Business Name): MR. TOKUNBO DIJI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 MERRICK RD
BELLMORE NY
11710-5730
US

IV. Provider business mailing address

157 BROOKLYN AVE
WESTBURY NY
11590-3915
US

V. Phone/Fax

Practice location:
  • Phone: 516-590-7575
  • Fax:
Mailing address:
  • Phone: 516-455-1131
  • Fax: 516-455-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: