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General NPI Number Information
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NPI Number | 1376646364
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Entity Type | Individual
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Provider Name | BOLANLE A AKINGBOYE D. O.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 1 SEYMOUR ST
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3771
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Country | US
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Telephone | 973-744-6939
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Fax | 973-744-0365
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Provider Business Mailing Address
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Address Line | 1 DIAMOND HILL RD
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City | BERKELEY HEIGHTS
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State | NJ
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Zip | 07922-2104
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Country | US
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Telephone | 973-744-6939
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Fax | 973-744-0365
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MB08107100
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License Number State | NJ
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