Healthcare Provider Details

I. General information

NPI: 1700175767
Provider Name (Legal Business Name): ADELEYE BABALOLA PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 01/09/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12205 FLATLANDS AVE APT-4G
BROOKLYN NY
11207-9052
US

IV. Provider business mailing address

12205 FLATLANDS AVE APT-4G
BROOKLYN NY
11207-9052
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-2100
  • Fax:
Mailing address:
  • Phone: 718-671-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberF406110-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF406110-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: