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General NPI Number Information
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NPI Number | 1073570081
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Entity Type | Individual
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Provider Name | OLUSEGUN M ADEONIGBAGBE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 19203 JAMAICA AVE
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City | HOLLIS
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State | NY
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Zip | 11423-2529
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Country | US
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Telephone | 718-217-7744
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Fax | 718-217-7233
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Provider Business Mailing Address
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Address Line | 1 NORFOLK DRIVE E
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City | ELMONT
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State | NY
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Zip | 11003
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Country | US
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Telephone | 718-217-7744
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Fax | 718-217-7233
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 201260
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License Number State | NY
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