Provider Demographics
NPI:1255771721
Name:ABORISADE, BOLAJI YEWANDE (LPN)
Entity type:Individual
Prefix:
First Name:BOLAJI
Middle Name:YEWANDE
Last Name:ABORISADE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 N ELLIOTT PL
Mailing Address - Street 2:APT 13G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 N ELLIOTT PL
Practice Address - Street 2:APT 13G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1043
Practice Address - Country:US
Practice Address - Phone:347-725-6114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310710164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse