Provider Demographics
NPI:1144324559
Name:DADA, TOKUNBO T (MD)
Entity type:Individual
Prefix:
First Name:TOKUNBO
Middle Name:T
Last Name:DADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 UNION AVENUE
Mailing Address - Street 2:SUTIE 702
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111
Mailing Address - Country:US
Mailing Address - Phone:973-373-7110
Mailing Address - Fax:973-373-0076
Practice Address - Street 1:50 UNION AVENUE
Practice Address - Street 2:SUTIE 702
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111
Practice Address - Country:US
Practice Address - Phone:973-373-7110
Practice Address - Fax:973-373-0076
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04826700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ343730201Medicaid