Provider Demographics
NPI:1114360666
Name:ADASOFUNJO, OLUWABUKOLA PRINCESS (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUWABUKOLA
Middle Name:PRINCESS
Last Name:ADASOFUNJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:OLUWABUKOLA
Other - Middle Name:PRINCESS
Other - Last Name:ALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:FORT HEALTH
Mailing Address - Street 2:613 WASHINGTON BLVD
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310
Mailing Address - Country:US
Mailing Address - Phone:201-208-2616
Mailing Address - Fax:973-250-4028
Practice Address - Street 1:87 RTE 17 N
Practice Address - Street 2:STE 118
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607
Practice Address - Country:US
Practice Address - Phone:551-996-4450
Practice Address - Fax:551-996-5729
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA111186002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry