Provider Demographics
NPI:1376646364
Name:AKINGBOYE, BOLANLE A (D O)
Entity Type:Individual
Prefix:
First Name:BOLANLE
Middle Name:A
Last Name:AKINGBOYE
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:973-744-6939
Mailing Address - Fax:973-744-0365
Practice Address - Street 1:1 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3771
Practice Address - Country:US
Practice Address - Phone:973-744-6939
Practice Address - Fax:973-744-0365
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08107100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD08943400OtherCDS
NJ0124567Medicaid