Provider Demographics
NPI:1477829984
Name:ADEJOKE BABALOLA, DPM, PC
Entity Type:Organization
Organization Name:ADEJOKE BABALOLA, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEJOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BABALOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-470-2879
Mailing Address - Street 1:11546 MEXICO ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:184 E 70TH ST
Practice Address - Street 2:SUITEB1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5154
Practice Address - Country:US
Practice Address - Phone:347-247-0206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006283261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric