Provider Demographics
NPI:1093304107
Name:AINA, ADEBAYO OLAMIDE
Entity Type:Individual
Prefix:
First Name:ADEBAYO
Middle Name:OLAMIDE
Last Name:AINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8413 AVENUE K APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4238
Mailing Address - Country:US
Mailing Address - Phone:914-343-9392
Mailing Address - Fax:
Practice Address - Street 1:8413 AVENUE K APT 2D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4238
Practice Address - Country:US
Practice Address - Phone:914-343-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026146363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty