Provider Demographics
NPI:1407090095
Name:ADENIYI, ADERONKE OLUPONLE
Entity Type:Individual
Prefix:
First Name:ADERONKE
Middle Name:OLUPONLE
Last Name:ADENIYI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:CARDIOLOGY, THIRD FLOOR
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1056
Mailing Address - Country:US
Mailing Address - Phone:315-769-1111
Mailing Address - Fax:315-769-1118
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:CARDIOLOGY, THIRD FLOOR
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1056
Practice Address - Country:US
Practice Address - Phone:315-769-1111
Practice Address - Fax:315-769-1118
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284456207RC0000X
VT042.0013696207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease