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General NPI Number Information
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NPI Number | 1902816051
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Entity Type | Organization
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Legal Business Name | FOUNTAIN PULMONARY P.C
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 800 MANOR RD SUITE 3
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City | STATEN ISLAND
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State | NY
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Zip | 10314-7034
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Country | US
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Telephone | 347-562-2753
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Fax | 347-289-5100
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Provider Business Mailing Address
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Address Line | 800 MANOR RD SUITE 3
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City | STATEN ISLAND
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State | NY
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Zip | 10314-7034
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Country | US
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Telephone | 347-562-2753
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Fax | 347-289-5100
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ADEBAMBO DOLAPO OLAJITAN
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Credential | M.D., FCCP
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Telephone | 347-562-2753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 212276
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License Number State | NY
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