MEDICARE: ADEOLA O AYODEJI 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
1	208000000X	Pediatrics Physician	001909	NY
2	208000000X	Pediatrics Physician	241089	NY
3	208000000X	Pediatrics Physician	241089-1	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

General Provider Information

NPI Number	:	1689660201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEOLA O AYODEJI MD

Provider Business Mailing Address
First Line	:	2570 ROUTE 9W
Second Line	:	SUITE 10
City	:	CORNWALL
State	:	NY
Zip	:	12518-1323
Country	:	US
Telephone Number	:	845-220-3100
Fax Number	:	845-534-2940

Provider Business Practice Location Address
First Line	:	147 LAKE STREET
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12550-5242
Country	:	US
Telephone Number	:	845-563-8000
Fax Number	:	845-563-8096

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	09/30/2016

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