Provider Demographics
NPI:1467771303
Name:AJAYI, OLUSEGUN AYOOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUSEGUN
Middle Name:AYOOLA
Last Name:AJAYI
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 1:591 E 82ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3118
Mailing Address - Country:US
Mailing Address - Phone:818-309-8937
Mailing Address - Fax:347-312-3436
Practice Address - Street 1:451 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2054
Practice Address - Country:US
Practice Address - Phone:718-245-4570
Practice Address - Fax:718-245-4777
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255975207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology