Provider Demographics
NPI:1417488511
Name:MBOLU, GEORGE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:MBOLU
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-4837
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:2 N VILLAGE BLVD STE 2A
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3592
Practice Address - Country:US
Practice Address - Phone:973-579-3444
Practice Address - Fax:908-522-5121
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2023-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA11018000207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine