Provider Demographics
NPI:1073074969
Name:AWONIYI, OLASUMBO OMOWONUOLA (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:OLASUMBO
Middle Name:OMOWONUOLA
Last Name:AWONIYI
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:DR
Other - First Name:OLASUMBO
Other - Middle Name:OMOWONUOLA
Other - Last Name:SOYOOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,MPH
Mailing Address - Street 1:230 E RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4142
Mailing Address - Country:US
Mailing Address - Phone:201-967-4000
Mailing Address - Fax:
Practice Address - Street 1:230 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4142
Practice Address - Country:US
Practice Address - Phone:201-967-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11326400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine