MEDICARE: DR. OLAKUNLE KAYODE OLUWOLE 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	208600000X	Surgery Physician	25MA07993500	NJ
2	208600000X	Surgery Physician	MD428526	PA
3	208600000X	Surgery Physician	047735	CT
4	208600000X	Surgery Physician	212153	NY

General Provider Information

NPI Number	:	1932177144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLAKUNLE KAYODE OLUWOLE M.D.

Provider Business Mailing Address
First Line	:	379 OLD TAPPAN RD
Second Line	:
City	:	OLD TAPPAN
State	:	NJ
Zip	:	07675-6806
Country	:	US
Telephone Number	:	201-681-9700
Fax Number	:	201-681-9700

Provider Business Practice Location Address
First Line	:	379 OLD TAPPAN RD
Second Line	:
City	:	OLD TAPPAN
State	:	NJ
Zip	:	07675-6806
Country	:	US
Telephone Number	:	631-581-4400
Fax Number	:	631-277-3750

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	11/18/2020

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