Healthcare Provider Details

I. General information

NPI: 1114001054
Provider Name (Legal Business Name): AYOADE O. ADENIYI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

IV. Provider business mailing address

1650 SELWYN AVE SUITE 6D
BRONX NY
10457-7626
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-5760
  • Fax: 718-518-5124
Mailing address:
  • Phone: 718-960-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number222671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: