Provider Demographics
NPI:1659647261
Name:ADEGUNLE, ADELAJU RUTH (REGISTERED NURSE)
Entity Type:Individual
Prefix:MISS
First Name:ADELAJU
Middle Name:RUTH
Last Name:ADEGUNLE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MATTELINE ST
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2618
Mailing Address - Country:US
Mailing Address - Phone:718-573-5959
Mailing Address - Fax:718-573-5966
Practice Address - Street 1:272 MACDONOUGH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1007
Practice Address - Country:US
Practice Address - Phone:718-573-5959
Practice Address - Fax:718-573-5966
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY554529-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse