Provider Demographics
NPI:1942443858
Name:FABANWO, IBIYEMI DONALD (BA)
Entity type:Individual
Prefix:MR
First Name:IBIYEMI
Middle Name:DONALD
Last Name:FABANWO
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 RECTOR ST FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1733
Mailing Address - Country:US
Mailing Address - Phone:212-385-3030
Mailing Address - Fax:
Practice Address - Street 1:10205 63RD RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1048
Practice Address - Country:US
Practice Address - Phone:347-426-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health