=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831605435
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LENOX MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2017
-----------------------------------------------------
Last Update Date | 12/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 SAINT GEORGES AVE STE 111
-----------------------------------------------------
City | RAHWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07065-2713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-686-6030
-----------------------------------------------------
Fax | 732-453-6171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 SAINT GEORGES AVE STE 111
-----------------------------------------------------
City | RAHWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07065-2713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BOLA FADIPE
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 732-686-6030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00468500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------