Healthcare Provider Details

I. General information

NPI: 1679769152
Provider Name (Legal Business Name): LAURELTON HEART SPECIALIST P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22414 MERRICK BLVD
LAURELTON NY
11413-2023
US

IV. Provider business mailing address

PO BOX 29
ROSLYN NY
11576-0029
US

V. Phone/Fax

Practice location:
  • Phone: 718-949-9400
  • Fax: 718-228-3636
Mailing address:
  • Phone: 718-949-9400
  • Fax: 718-228-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number202443
License Number StateNY

VIII. Authorized Official

Name: DR. OLAKUNLE AKINBOBOYE
Title or Position: PRESIDENT
Credential: MD
Phone: 718-949-9400