Provider Demographics
NPI:1477072148
Name:ADENLOLA, FATIMAT BINTU FUNKE
Entity Type:Individual
Prefix:MRS
First Name:FATIMAT BINTU
Middle Name:FUNKE
Last Name:ADENLOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:FATIMAT BINTU
Other - Middle Name:F
Other - Last Name:ADENLOLA
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:244 S KING ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4233
Mailing Address - Country:US
Mailing Address - Phone:516-708-7748
Mailing Address - Fax:
Practice Address - Street 1:40 ELMONT RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1603
Practice Address - Country:US
Practice Address - Phone:347-542-5667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program