Active NPI
Bolaji Isijola
- Licensed Practical Nurse
- Queens Village, NY
National Provider Identifier
1629583216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 330801
- Practice address
- 11042 207TH St
Queens Village, NY 11429-1706 - Phone
- (917) 627-0760
- NPI assigned
- Dec 5, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 330801 | NY | Primary |
Addresses
Primary practice location
11042 207TH St
Queens Village, NY 11429-1706
Mailing address
11042 207TH St
Queens Village, NY 11429-1706
Phone (917) 627-0760
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 330801 | NY | MD | Pediatric Hematology & Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512432000000",
"number": "1629583216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11042 207TH ST",
"city": "QUEENS VILLAGE",
"state": "NY",
"postal_code": "114291706",
"telephone_number": "917-627-0760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11042 207TH ST",
"city": "QUEENS VILLAGE",
"state": "NY",
"postal_code": "114291706",
"telephone_number": "917-627-0760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISIJOLA",
"first_name": "BOLAJI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-05",
"last_updated": "2017-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "330801",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Queens Village, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.