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General NPI Number Information
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NPI Number | 1881027522
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Entity Type | Organization
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Legal Business Name | DR. OLUYEMI O BADERO, PHYSICIAN, P.C.
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Dates
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Enumeration Date | 08/16/2013
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 1932 ROCKAWAY PKWY
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City | BROOKLYN
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State | NY
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Zip | 11236-5506
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Country | US
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Telephone | 718-209-8000
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Fax | 718-444-2887
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Provider Business Mailing Address
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Address Line | 10819 FLATLANDS 8TH ST
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City | BROOKLYN
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State | NY
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Zip | 11236-4644
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Country | US
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Telephone | 718-209-8000
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Fax | 718-444-2887
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. OLUYEMI O BADERO
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Credential | MD
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Telephone | 718-209-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 190052
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License Number State | NY
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