Provider Demographics
NPI:1184654014
Name:ODUJEBE, OLADAPO A (MD)
Entity Type:Individual
Prefix:
First Name:OLADAPO
Middle Name:A
Last Name:ODUJEBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SOHO DRIVE
Mailing Address - Street 2:UNIT 102
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1138
Mailing Address - Country:US
Mailing Address - Phone:732-910-3276
Mailing Address - Fax:
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428043207P00000X
NJ25MA08145500207P00000X
NY241272207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00357155OtherRAIL ROAD MEDICARE
NJ0122734Medicaid
NJ0122734Medicaid
NJ105993XZ2Medicare PIN
NJ105993SN3Medicare PIN