MEDICARE: DR. ADEBAMBO DOLAPO OLAJITAN M.D. FCCP

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
1	207RP1001X	Pulmonary Disease Physician	212276	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11455768	OTHER		CAQH NUMBER

General Provider Information

NPI Number	:	1598768905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADEBAMBO DOLAPO OLAJITAN M.D. FCCP

Provider Business Mailing Address
First Line	:	800 MANOR RD
Second Line	:	SUITE #3
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-7034
Country	:	US
Telephone Number	:	347-562-2753
Fax Number	:	347-289-5100

Provider Business Practice Location Address
First Line	:	800 MANOR RD
Second Line	:	SUITE #3
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-7034
Country	:	US
Telephone Number	:	347-562-2753
Fax Number	:	347-289-5100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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