Healthcare Provider Details

I. General information

NPI: 1417220146
Provider Name (Legal Business Name): ROTANNA I ADEFOWOKAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROTANNA I ANOSIKE MD

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 W PARKWAY
POMPTON PLAINS NJ
07444-1647
US

IV. Provider business mailing address

38 PARK ST APT 23E
FLORHAM PARK NJ
07932-1746
US

V. Phone/Fax

Practice location:
  • Phone: 732-423-0761
  • Fax:
Mailing address:
  • Phone: 732-423-0761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD445239
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA09375600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: