Healthcare Provider Details

I. General information

NPI: 1518916584
Provider Name (Legal Business Name): EMIOLA ASEMOTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 VENTNOR AVE SUITE 14
VENTNOR NJ
08406-2167
US

IV. Provider business mailing address

6601 VENTNOR AVE SUITE 14
VENTNOR NJ
08406-2167
US

V. Phone/Fax

Practice location:
  • Phone: 609-487-6507
  • Fax: 609-487-6508
Mailing address:
  • Phone: 856-755-1616
  • Fax: 856-755-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MA06156800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: