Provider Demographics
NPI:1467504431
Name:BOSEDE, KAREEM OMOFOLAYEMI (CRNA)
Entity type:Individual
Prefix:MR
First Name:KAREEM
Middle Name:OMOFOLAYEMI
Last Name:BOSEDE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:683 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-3926
Mailing Address - Country:US
Mailing Address - Phone:201-664-2925
Mailing Address - Fax:
Practice Address - Street 1:506 MALCOLM X BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY443506-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered