Healthcare Provider Details

I. General information

NPI: 1649112095
Provider Name (Legal Business Name): BABALOLA MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 LAWRENCE CT
VALLEY STREAM NY
11581-2709
US

IV. Provider business mailing address

1014 LAWRENCE CT
VALLEY STREAM NY
11581-2709
US

V. Phone/Fax

Practice location:
  • Phone: 347-886-8948
  • Fax:
Mailing address:
  • Phone: 347-886-8948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. OLAWUMI O BABALOLA
Title or Position: DIRECTOR
Credential: MD
Phone: 347-886-8948