Provider Demographics
NPI:1235250820
Name:DELE-MICHAEL, ADEBOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEBOLA
Middle Name:
Last Name:DELE-MICHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADEBOLA
Other - Middle Name:
Other - Last Name:ADENIRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:234 CENTRAL PARK W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6003
Mailing Address - Country:US
Mailing Address - Phone:212-229-0007
Mailing Address - Fax:
Practice Address - Street 1:116 CENTRAL PARK S STE 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1527
Practice Address - Country:US
Practice Address - Phone:212-229-0007
Practice Address - Fax:212-202-6350
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08768300207N00000X
NY256265207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology