Healthcare Provider Details

I. General information

NPI: 1447205836
Provider Name (Legal Business Name): BABATUNDE ADEYEMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 RALPH AVE
BROOKLYN NY
11236-3319
US

IV. Provider business mailing address

1711 RALPH AVE
BROOKLYN NY
11236-3319
US

V. Phone/Fax

Practice location:
  • Phone: 718-649-6324
  • Fax:
Mailing address:
  • Phone: 718-649-6324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number2262761
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number226276
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: