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General NPI Number Information
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NPI Number | 1467319491
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Entity Type | Individual
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Provider Name | ROOSEVELT BANTOE TOTAYE CRNP
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Gender | Male
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 508 N FENWICK ST
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City | ALLENTOWN
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State | PA
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Zip | 18109-1977
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Country | US
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Telephone | 484-350-8124
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Fax |
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Provider Business Mailing Address
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Address Line | 508 N FENWICK ST
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City | ALLENTOWN
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State | PA
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Zip | 18109-1977
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Country | US
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Telephone | 484-350-8124
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | SP032033
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | SP032033
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | SP032033
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | SP032033
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | SP032033
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License Number State | PA
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