Organization
LUNG DOCTOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AKINGBOJU GBAYSOMORE DO (OWNER)
(973) 399-9090
Entity
Organization
Contact information
Practice address
722 SANFORD AVE, NEWARK, NJ 07106-3627
(973) 399-9090
Mailing address
722 SANFORD AVE, NEWARK, NJ 07106-3627
(973) 399-9090
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
MA58862
NJ
207RS0012X
Sleep Medicine (Internal Medicine) Physician
MA58862
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7240406
—
NJ
Enumeration date
05/23/2006
Last updated
07/30/2008
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