Provider Demographics
NPI:1639908692
Name:BOLLYTRADE AND SON, INC.
Entity type:Organization
Organization Name:BOLLYTRADE AND SON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GBOLAGUNTE
Authorized Official - Middle Name:ABIDEEN
Authorized Official - Last Name:AYODELE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:754-249-0600
Mailing Address - Street 1:4200 NW 16TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5835
Mailing Address - Country:US
Mailing Address - Phone:754-249-0600
Mailing Address - Fax:
Practice Address - Street 1:4200 NW 16TH ST STE 220
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-5835
Practice Address - Country:US
Practice Address - Phone:754-249-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care