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General NPI Number Information
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NPI Number | 1437210119
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Entity Type | Organization
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Legal Business Name | JOLADE MEDICAL & REHAB.P.C.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | 1135 ALLERTON AVE
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City | BRONX
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State | NY
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Zip | 10469
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Country | US
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Telephone | 347-427-2953
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Fax | 347-427-2953
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Provider Business Mailing Address
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Address Line | 1135 ALLERTON AVE
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City | BRONX
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State | NY
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Zip | 10469-5316
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Country | US
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Telephone | 347-427-2953
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Fax | 347-427-2953
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. THOMAS OMOTOLA TEYIBO
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Credential | M.D
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Telephone | 347-427-2953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 215979
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 125979
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License Number State | NY
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