Healthcare Provider Details

I. General information

NPI: 1740675057
Provider Name (Legal Business Name): PAUL O ADENUGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 FRANKLIN AVE
GARDEN CITY NY
11530-2913
US

IV. Provider business mailing address

999 FRANKLIN AVE
GARDEN CITY NY
11530-2913
US

V. Phone/Fax

Practice location:
  • Phone: 516-231-6383
  • Fax:
Mailing address:
  • Phone: 405-219-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number303070
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number303070
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number303070
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: