Provider Demographics
NPI:1073718185
Name:OKUNOLA, OLADOTUN A (MD)
Entity Type:Individual
Prefix:DR
First Name:OLADOTUN
Middle Name:A
Last Name:OKUNOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MADISON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6967
Mailing Address - Country:US
Mailing Address - Phone:973-285-1446
Mailing Address - Fax:973-605-8854
Practice Address - Street 1:310 MADISON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6967
Practice Address - Country:US
Practice Address - Phone:973-285-1446
Practice Address - Fax:973-605-8854
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA082449002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00441926OtherRR MCR
NJ0138754Medicaid
NJ114801DN8Medicare PIN