Healthcare Provider Details

I. General information

NPI: 1437210119
Provider Name (Legal Business Name): JOLADE MEDICAL & REHAB.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 ALLERTON AVE
BRONX NY
10469
US

IV. Provider business mailing address

1135 ALLERTON AVE
BRONX NY
10469-5316
US

V. Phone/Fax

Practice location:
  • Phone: 347-427-2953
  • Fax: 347-427-2953
Mailing address:
  • Phone: 347-427-2953
  • Fax: 347-427-2953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number215979
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number125979
License Number StateNY

VIII. Authorized Official

Name: DR. THOMAS OMOTOLA TEYIBO
Title or Position: DIRECTOR
Credential: M.D
Phone: 347-427-2953