Provider Demographics
NPI:1407900053
Name:ADEIGBOLA, AYODELE EBUN (MD)
Entity Type:Individual
Prefix:DR
First Name:AYODELE
Middle Name:EBUN
Last Name:ADEIGBOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2717
Mailing Address - Country:US
Mailing Address - Phone:917-459-4560
Mailing Address - Fax:
Practice Address - Street 1:205 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2717
Practice Address - Country:US
Practice Address - Phone:917-459-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2053462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
297BH1Medicare PIN
H89010Medicare UPIN