Provider Demographics
NPI:1689982217
Name:BOLORUNDURO, OLUWASEYI BOLAJI (MBBS MPH)
Entity Type:Individual
Prefix:DR
First Name:OLUWASEYI
Middle Name:BOLAJI
Last Name:BOLORUNDURO
Suffix:
Gender:M
Credentials:MBBS MPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:161 FORT WASHINGTON AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:443-850-4972
Mailing Address - Fax:212-342-3660
Practice Address - Street 1:161 FORT WASHINGTON AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:443-850-4972
Practice Address - Fax:212-342-3660
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-8947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine