Basic Information
| Provider Information | |||||||||
| NPI: | 1881908705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADELEKE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1669 UNIVERSITY BLVD | ||||||||
| Address2: | APT-5A | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104536997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186712100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1669 UNIVERSITY BLVD | ||||||||
| Address2: | APT-5A | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104536997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186712100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2010 | ||||||||
| LastUpdateDate: | 08/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 301709 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.