Healthcare Provider Details

I. General information

NPI: 1467748335
Provider Name (Legal Business Name): ADEKUNLE VINCENT KILADEJO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 07/21/2022
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

493 ESSEX ST
HACKENSACK NJ
07601-1215
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-6324
  • Fax:
Mailing address:
  • Phone: 718-270-6324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA10869000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MA10869000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: