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NPI Code Detail

MEDICARE: DR. ROTANNA I ADEFOWOKAN MD

MEDICARE: DR. ROTANNA I ADEFOWOKAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramNJ
2207V00000XObstetrics & Gynecology PhysicianMD445239PA
3390200000XStudent in an Organized Health Care Education/Training ProgramNY
4207V00000XObstetrics & Gynecology Physician25MA09375600NJ

General Provider Information

NPI Number : 1417220146
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROTANNA I ADEFOWOKAN MD
Provider Business Mailing Address
First Line : 38 PARK ST APT 23E
Second Line :
City : FLORHAM PARK
State : NJ
Zip : 07932-1746
Country : US
Telephone Number : 732-423-0761
Fax Number :
Provider Business Practice Location Address
First Line : 97 W PARKWAY
Second Line :
City : POMPTON PLAINS
State : NJ
Zip : 07444-1647
Country : US
Telephone Number : 732-423-0761
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2012
Last Update Date : 12/11/2025

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