Provider Demographics
NPI:1689613564
Name:ADEYANJU, OLUFUNMILAYO OLAJUMOKE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUFUNMILAYO
Middle Name:OLAJUMOKE
Last Name:ADEYANJU
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 1:675 NEREID AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1514
Mailing Address - Country:US
Mailing Address - Phone:718-655-7777
Mailing Address - Fax:
Practice Address - Street 1:675 NEREID AVE
Practice Address - Street 2:OPTIMUM FAMILY MEDICINE PC
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1514
Practice Address - Country:US
Practice Address - Phone:718-655-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA079357200207Q00000X
NYBA9939250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI45950Medicare UPIN
NJI45950Medicare ID - Type Unspecified
NY4503P1Medicare PIN
NJ096157Medicare UPIN