Provider Demographics
NPI:1629377445
Name:POPOOLA, ISAAC ABIOLA
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:ABIOLA
Last Name:POPOOLA
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 1:357 SCHLEY ST APT B4
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-1036
Mailing Address - Country:US
Mailing Address - Phone:862-237-8228
Mailing Address - Fax:
Practice Address - Street 1:357 SCHLEY APTB4
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112
Practice Address - Country:US
Practice Address - Phone:862-237-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR11395600163W00000X
NY546207-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse