Provider Demographics
NPI:1598877839
Name:BADERO, OLUYEMI O (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:OLUYEMI
Middle Name:O
Last Name:BADERO
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10819 FLATLANDS 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4644
Mailing Address - Country:US
Mailing Address - Phone:718-209-8000
Mailing Address - Fax:718-444-2887
Practice Address - Street 1:1932 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5506
Practice Address - Country:US
Practice Address - Phone:718-209-8000
Practice Address - Fax:718-444-2887
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190052-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01717266Medicaid
NY91Z061Medicare PIN
NY01717266Medicaid