Provider Demographics
NPI:1871102145
Name:MAKINDE, BUKOLA
Entity type:Individual
Prefix:
First Name:BUKOLA
Middle Name:
Last Name:MAKINDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 SCHERMERHORN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4802
Mailing Address - Country:US
Mailing Address - Phone:347-350-3366
Mailing Address - Fax:
Practice Address - Street 1:41 SCHERMERHORN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4802
Practice Address - Country:US
Practice Address - Phone:347-350-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276399164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY276399Medicaid