Healthcare Provider Details

I. General information

NPI: 1225233877
Provider Name (Legal Business Name): OLANREWAJU ALADE SOREMEKUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E RIDGEWOOD AVE STE 415S
PARAMUS NJ
07652-3917
US

IV. Provider business mailing address

140 E RIDGEWOOD AVE STE 415S
PARAMUS NJ
07652-3917
US

V. Phone/Fax

Practice location:
  • Phone: 551-444-6300
  • Fax:
Mailing address:
  • Phone: 551-444-6300
  • Fax: 201-380-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberL-228648
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA09765800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD439459
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number25MA09765800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: