Individual
SIMBIAT O AJAYI AJIBOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17631 130TH AVE, 1ST FLOOR, JAMAICA, NY 11434-5823
(718) 801-7581
Mailing address
17631 130TH AVE, 1ST FLOOR, JAMAICA, NY 11434-5823
(718) 801-7581
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
614041
NY
363LP2300X
Primary Care Nurse Practitioner
Primary
F307777
NY
Other
Enumeration date
04/30/2009
Last updated
09/01/2016
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