Provider Demographics
NPI:1003377359
Name:LADEJI, ABAYOMI OLUFUNMILAYO
Entity Type:Individual
Prefix:
First Name:ABAYOMI
Middle Name:OLUFUNMILAYO
Last Name:LADEJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUMMIT AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-3003
Mailing Address - Country:US
Mailing Address - Phone:718-406-7652
Mailing Address - Fax:
Practice Address - Street 1:1593 E 94TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5223
Practice Address - Country:US
Practice Address - Phone:718-406-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253903-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse