Provider Demographics
NPI:1093961732
Name:IYANOYE, ABIMBOLA OLAMIDE (MD)
Entity Type:Individual
Prefix:DR
First Name:ABIMBOLA
Middle Name:OLAMIDE
Last Name:IYANOYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ABIMBOLA
Other - Middle Name:OLAMIDE
Other - Last Name:OTELAJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1702 VAN WICKLE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-2609
Mailing Address - Country:US
Mailing Address - Phone:507-254-2070
Mailing Address - Fax:
Practice Address - Street 1:1702 VAN WICKLE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-2609
Practice Address - Country:US
Practice Address - Phone:507-254-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08606400208000000X
IL036.121783208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics