Healthcare Provider Details

I. General information

NPI: 1922414622
Provider Name (Legal Business Name): ADEYEMI OGUNKOYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 LENOX RD APT 6D
BROOKLYN NY
11226-2260
US

IV. Provider business mailing address

337 LENOX RD APT 6D
BROOKLYN NY
11226-2260
US

V. Phone/Fax

Practice location:
  • Phone: 917-692-7520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number262006
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: