Basic Information
| Provider Information | |||||||||
| NPI: | 1114001054 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ADENIYI | ||||||||
| FirstName: | AYOADE | ||||||||
| MiddleName: | O. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 SELWYN AVE | ||||||||
| Address2: | SUITE 6D | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104577626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189601417 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1650 GRAND CONCOURSE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104577606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185185760 | ||||||||
| FaxNumber: | 7185185124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 02/18/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 222671 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 01733857 | 05 | NY | MEDICAID |