Provider Demographics
NPI:1619100633
Name:BOLAJI, OLUBUNMI ABIYE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUBUNMI
Middle Name:ABIYE
Last Name:BOLAJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6080 JERICHO TPKE STE 205
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2808
Mailing Address - Country:US
Mailing Address - Phone:631-486-4834
Mailing Address - Fax:631-486-5029
Practice Address - Street 1:6080 JERICHO TPKE STE 205
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2808
Practice Address - Country:US
Practice Address - Phone:631-486-4834
Practice Address - Fax:631-486-5029
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254613207RH0002X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03203005Medicaid