Provider Demographics
NPI:1649204959
Name:UTHMAN, ADEOLA R (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEOLA
Middle Name:R
Last Name:UTHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:917 PINECROFT CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1711
Mailing Address - Country:US
Mailing Address - Phone:201-891-3597
Mailing Address - Fax:201-891-3598
Practice Address - Street 1:225 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1361
Practice Address - Country:US
Practice Address - Phone:718-282-3340
Practice Address - Fax:718-469-4616
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY210407207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
5P8451Medicare UPIN
G62305Medicare ID - Type Unspecified