Provider Demographics
NPI:1679769152
Name:LAURELTON HEART SPECIALIST P.C.
Entity Type:Organization
Organization Name:LAURELTON HEART SPECIALIST P.C.
Other - Org Name:STRONG HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAKUNLE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINBOBOYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-949-9400
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-0029
Mailing Address - Country:US
Mailing Address - Phone:718-949-9400
Mailing Address - Fax:718-228-3636
Practice Address - Street 1:22414 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2023
Practice Address - Country:US
Practice Address - Phone:718-949-9400
Practice Address - Fax:718-228-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202443207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF73230Medicare UPIN
NY05996Medicare PIN