Healthcare Provider Details

I. General information

NPI: 1013160613
Provider Name (Legal Business Name): BOLANLE OLAJUMOKE BELLO N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 BRONX BLVD
BRONX NY
10470-1407
US

IV. Provider business mailing address

4401 BRONX BLVD
BRONX NY
10470-1407
US

V. Phone/Fax

Practice location:
  • Phone: 718-304-7000
  • Fax: 718-304-9217
Mailing address:
  • Phone: 718-304-7000
  • Fax: 718-304-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401162-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: