Provider Demographics
NPI:1447697834
Name:BANKOLE, OMOLABAKE O (MD)
Entity type:Individual
Prefix:
First Name:OMOLABAKE
Middle Name:O
Last Name:BANKOLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2330 ROUTE 33
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-1430
Mailing Address - Country:US
Mailing Address - Phone:609-303-4400
Mailing Address - Fax:609-303-4401
Practice Address - Street 1:2330 ROUTE 33
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1430
Practice Address - Country:US
Practice Address - Phone:609-303-4400
Practice Address - Fax:609-303-4401
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10038200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine