Individual
BOLAJI ISIJOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11042 207TH ST, QUEENS VILLAGE, NY 11429-1706
(917) 627-0760
Mailing address
11042 207TH ST, QUEENS VILLAGE, NY 11429-1706
(917) 627-0760
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
330801
NY
Other
Enumeration date
12/05/2017
Last updated
12/05/2017
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