Healthcare Provider Details

I. General information

NPI: 1205321387
Provider Name (Legal Business Name): OLUWATOYIN DAMILOLA FAJOBI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CHURCH ST
SARATOGA SPRINGS NY
12866-1003
US

IV. Provider business mailing address

36 GREENBRIER WAY
HALFMOON NY
12065-6100
US

V. Phone/Fax

Practice location:
  • Phone: 914-314-9812
  • Fax:
Mailing address:
  • Phone: 914-314-9812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number312769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: