Provider Demographics
NPI:1952717324
Name:LANIYAN, ABIMBOLA (NP)
Entity Type:Individual
Prefix:
First Name:ABIMBOLA
Middle Name:
Last Name:LANIYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SWEETFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-2612
Mailing Address - Country:US
Mailing Address - Phone:646-528-3284
Mailing Address - Fax:
Practice Address - Street 1:120 SWEETFIELD CIR
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-2612
Practice Address - Country:US
Practice Address - Phone:646-528-3284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2015-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY675217-1163W00000X
NY382531363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse