Provider Demographics
NPI:1437210119
Name:JOLADE MEDICAL & REHAB.P.C.
Entity Type:Organization
Organization Name:JOLADE MEDICAL & REHAB.P.C.
Other - Org Name:JOLADE MEDICAL AND REHAB.P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:OMOTOLA
Authorized Official - Last Name:TEYIBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-427-2953
Mailing Address - Street 1:1135 ALLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5316
Mailing Address - Country:US
Mailing Address - Phone:347-427-2953
Mailing Address - Fax:347-427-2953
Practice Address - Street 1:1135 ALLERTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469
Practice Address - Country:US
Practice Address - Phone:347-427-2953
Practice Address - Fax:347-427-2953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125979261Q00000X
NY215979261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center