Provider Demographics
NPI:1023198801
Name:ADEYEMO, ADENIKE ADERONKE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADENIKE
Middle Name:ADERONKE
Last Name:ADEYEMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4606
Mailing Address - Country:US
Mailing Address - Phone:646-500-4413
Mailing Address - Fax:718-292-9455
Practice Address - Street 1:3108 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:646-500-4413
Practice Address - Fax:718-292-9455
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03219514Medicaid
NY02268046Medicaid