MEDICARE: DR. OLUFUNMILAYO OLAJUMOKE ADEYANJU M.D.

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	207Q00000X	Family Medicine Physician	25MA079357200	NJ
2	207Q00000X	Family Medicine Physician	BA9939250	NY

General Provider Information

NPI Number	:	1689613564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLUFUNMILAYO OLAJUMOKE ADEYANJU M.D.

Provider Business Mailing Address
First Line	:	675 NEREID AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10470-1514
Country	:	US
Telephone Number	:	718-655-7777
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 NEREID AVE
Second Line	:	OPTIMUM FAMILY MEDICINE PC
City	:	BRONX
State	:	NY
Zip	:	10470-1514
Country	:	US
Telephone Number	:	718-655-7777
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	05/02/2013

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