Provider Demographics
NPI:1578082491
Name:OLORUNNISHOLA, TOYIN
Entity Type:Individual
Prefix:
First Name:TOYIN
Middle Name:
Last Name:OLORUNNISHOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 S BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5341
Mailing Address - Country:US
Mailing Address - Phone:516-884-7630
Mailing Address - Fax:
Practice Address - Street 1:A AND J BEHAVIORAL HEALTH, INC
Practice Address - Street 2:SUITE 302
Practice Address - City:BELLMORE, NY
Practice Address - State:NY
Practice Address - Zip Code:11710
Practice Address - Country:US
Practice Address - Phone:516-590-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst