MEDICARE: OLUWATOYIN T AJAYI MBBS

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	62179	CT
2	207Q00000X	Family Medicine Physician	250701	MA
3	207Q00000X	Family Medicine Physician	2019-01142	NC
4	207Q00000X	Family Medicine Physician	292657	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	:	1790912426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUWATOYIN T AJAYI MBBS

Provider Business Mailing Address
First Line	:	495 FLATBUSH AVE # C5
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	546 EASTERN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-1604
Country	:	US
Telephone Number	:	833-904-2273
Fax Number	:	617-414-2090

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

Provider Enumeration Date	:	06/21/2009
Last Update Date	:	02/16/2023

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