Provider Demographics
NPI:1063434447
Name:WALKS-AKINTOBI, PAULINE A (MD)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:A
Last Name:WALKS-AKINTOBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2607
Mailing Address - Country:US
Mailing Address - Phone:718-636-4500
Mailing Address - Fax:718-636-2998
Practice Address - Street 1:741 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4309
Practice Address - Country:US
Practice Address - Phone:973-483-1300
Practice Address - Fax:973-676-1396
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAW24780912080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1235300799Other37 N DAY
NJ5299608Medicaid
NJ1972778413Other1150 SPRINGFIELD
NJ1932370483Other444 WILLIAM STREET
NJ1235300799Other37 N DAY
NJ1972778413Other1150 SPRINGFIELD