Healthcare Provider Details

I. General information

NPI: 1356432678
Provider Name (Legal Business Name): ADENIYI OGUNKOYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 SANFORD AVENUE
IRVINGTON NJ
07111
US

IV. Provider business mailing address

964 SANFORD AVENUE
IRVINGTON NJ
07111
US

V. Phone/Fax

Practice location:
  • Phone: 973-371-9050
  • Fax: 973-371-2593
Mailing address:
  • Phone: 973-371-9050
  • Fax: 973-371-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA41628
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberMA41628
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: