Provider Demographics
NPI:1164464970
Name:AYINLA, RAJI MOHAMMED (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJI
Middle Name:MOHAMMED
Last Name:AYINLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1431
Mailing Address - Country:US
Mailing Address - Phone:718-220-4380
Mailing Address - Fax:
Practice Address - Street 1:3184 GRAND CONCOURSE APT 2E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1031
Practice Address - Country:US
Practice Address - Phone:718-220-4380
Practice Address - Fax:718-220-4375
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208113207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01667894Medicaid
NY01667894Medicaid