Healthcare Provider Details

I. General information

NPI: 1003050022
Provider Name (Legal Business Name): JUBRIL OYEKANMI OYEYEMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MADISON AVE
MOUNT HOLLY NJ
08060-2038
US

IV. Provider business mailing address

40 LAKE CTR 401 ROUTE 73 N SUITE 201A
MARLTON NJ
08053-3425
US

V. Phone/Fax

Practice location:
  • Phone: 609-914-6180
  • Fax: 609-914-6182
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD446405
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA09168400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: