Provider Demographics
NPI:1376603647
Name:DABIRI, TAJUDEEN OLADELE (MD)
Entity Type:Individual
Prefix:
First Name:TAJUDEEN
Middle Name:OLADELE
Last Name:DABIRI
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 1:1650 GRAND CONCOURSE
Mailing Address - Street 2:ADMIN/DEPT OF OB/GYN FL5
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7606
Mailing Address - Country:US
Mailing Address - Phone:718-239-8383
Mailing Address - Fax:718-239-8360
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:ADMIN/DEPT OF OB/GYN FL5
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-239-8383
Practice Address - Fax:718-239-8360
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243427207V00000X, 207V00000X
TXP6153207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02920529Medicaid
NY02920529Medicaid