Organization
PACE PEDIATRIC PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BOLANLE OLAJIDE MD (PRESIDENT)
(718) 771-8435
Entity
Organization
Contact information
Practice address
629 EASTERN PKWY, BROOKLYN, NY 11213-3339
(718) 771-8435
Mailing address
657 E 26TH ST APT 1U, BROOKLYN, NY 11210-2170
(718) 421-4246
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
210092
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0187839
—
NY
Enumeration date
02/09/2007
Last updated
08/22/2020
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