Provider Demographics
NPI:1720310360
Name:BABATUNDE, LOVELYN
Entity Type:Individual
Prefix:
First Name:LOVELYN
Middle Name:
Last Name:BABATUNDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 207TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1706
Mailing Address - Country:US
Mailing Address - Phone:718-464-5139
Mailing Address - Fax:
Practice Address - Street 1:505 E 120TH ST
Practice Address - Street 2:APT # 6C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3723
Practice Address - Country:US
Practice Address - Phone:212-410-7042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298625-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse