Provider Demographics
NPI:1518916584
Name:ASEMOTA, EMIOLA (MD)
Entity Type:Individual
Prefix:
First Name:EMIOLA
Middle Name:
Last Name:ASEMOTA
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 1:6601 VENTNOR AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:VENTNOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-2167
Mailing Address - Country:US
Mailing Address - Phone:856-755-1616
Mailing Address - Fax:856-755-0098
Practice Address - Street 1:6601 VENTNOR AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:VENTNOR
Practice Address - State:NJ
Practice Address - Zip Code:08406-2167
Practice Address - Country:US
Practice Address - Phone:609-487-6507
Practice Address - Fax:609-487-6508
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA061568002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0831582000OtherAMERIHEALTH HMO/PPO
5768408OtherAETNA PPO
NJ6482406Medicaid
925976OtherAETNA HMO
NJP2922657OtherOXFORD
NJ1164968OtherHORIZON NJ HEALTH
NJ23906OtherAMERIGROUP/AMERICAID