Provider Demographics
NPI:1235490178
Name:JOLAYEMI, AYODEJI
Entity Type:Individual
Prefix:
First Name:AYODEJI
Middle Name:
Last Name:JOLAYEMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 5TH AVE
Mailing Address - Street 2:APARTMENT 2J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-2704
Mailing Address - Country:US
Mailing Address - Phone:615-243-5625
Mailing Address - Fax:
Practice Address - Street 1:2186 5TH AVE
Practice Address - Street 2:APARTMENT 2J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2704
Practice Address - Country:US
Practice Address - Phone:615-243-5625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD4481042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program