Provider Demographics
NPI:1417245663
Name:ADELAJA, ADEDEJI RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:ADEDEJI
Middle Name:RICHARD
Last Name:ADELAJA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 URBAN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3831
Mailing Address - Country:US
Mailing Address - Phone:646-243-2571
Mailing Address - Fax:
Practice Address - Street 1:55 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-2243
Practice Address - Country:US
Practice Address - Phone:516-377-8014
Practice Address - Fax:516-377-8017
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine