Healthcare Provider Details

I. General information

NPI: 1902628332
Provider Name (Legal Business Name): HABEEBAH ADEDOLAPO MOSEBOLATAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WATERS PL
BRONX NY
10461-2723
US

IV. Provider business mailing address

951 HOE AVE APT 1H
BRONX NY
10459-3629
US

V. Phone/Fax

Practice location:
  • Phone: 929-348-3464
  • Fax:
Mailing address:
  • Phone: 347-638-9635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number827506-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: