1073532842 NPI number — DR. BRUNO NATHANIEL LATUNDE' COLE MD

Table of content: DR. BRUNO NATHANIEL LATUNDE' COLE MD (NPI 1073532842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073532842 NPI number — DR. BRUNO NATHANIEL LATUNDE' COLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
BRUNO
Provider Middle Name:
NATHANIEL LATUNDE'
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073532842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 ALEXANDER RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08540-6331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-919-0303
Provider Business Mailing Address Fax Number:
609-919-0008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 ALEXANDER RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-6331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-919-0303
Provider Business Practice Location Address Fax Number:
609-919-0008
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  25MA04022200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6398804 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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