Provider Demographics
NPI:1023387248
Name:AKINBOBOLA, ABIODUN (RN)
Entity Type:Individual
Prefix:
First Name:ABIODUN
Middle Name:
Last Name:AKINBOBOLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 GRAFF AVE # 21B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-3119
Mailing Address - Country:US
Mailing Address - Phone:347-641-3592
Mailing Address - Fax:
Practice Address - Street 1:266 GRAFF AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-3119
Practice Address - Country:US
Practice Address - Phone:347-641-3592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649682163W00000X
NYF347060363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY649682OtherRN LICENSE
NYF347060OtherFNP
NYF347060Medicaid