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General NPI Number Information
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NPI Number | 1922467620
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Entity Type | Organization
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Legal Business Name | KUPONIYI FAMILY MEDICINE
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 199 NEW RD SUITE 61-398
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City | LINWOOD
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State | NJ
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Zip | 08221-2025
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Country | US
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Telephone | 609-534-5859
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Fax |
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Provider Business Mailing Address
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Address Line | 199 NEW RD SUITE 61-398
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City | LINWOOD
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State | NJ
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Zip | 08221-2025
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MOJISOLA DABNEY
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Credential |
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Telephone | 609-534-5859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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