Provider Demographics
NPI:1598768905
Name:OLAJITAN, ADEBAMBO DOLAPO (MD FCCP)
Entity Type:Individual
Prefix:DR
First Name:ADEBAMBO
Middle Name:DOLAPO
Last Name:OLAJITAN
Suffix:
Gender:M
Credentials:MD FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MANOR RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7034
Mailing Address - Country:US
Mailing Address - Phone:347-562-2753
Mailing Address - Fax:347-289-5100
Practice Address - Street 1:800 MANOR RD
Practice Address - Street 2:SUITE #3
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7034
Practice Address - Country:US
Practice Address - Phone:347-562-2753
Practice Address - Fax:347-289-5100
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212276207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01883816Medicaid
11455768OtherCAQH NUMBER
NY01883816Medicaid
G81192Medicare UPIN