Basic Information
| Provider Information | |||||||||
| NPI: | 1376646364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AKINGBOYE | ||||||||
| FirstName: | BOLANLE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | D. O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 GROVE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567969207 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 HADDON AVE | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081033109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567573700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 12/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MB08107100 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0124567 | 05 | NJ | MEDICAID | D08943400 | 01 | NJ | CDS | OTHER |