Provider Demographics
NPI:1710296827
Name:LADEJOBI, SADIQ (RN)
Entity Type:Individual
Prefix:
First Name:SADIQ
Middle Name:
Last Name:LADEJOBI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2238 CRESTON AVE APT 12A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-2152
Mailing Address - Country:US
Mailing Address - Phone:646-271-6281
Mailing Address - Fax:
Practice Address - Street 1:1896 WALTON AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:646-271-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402733363LP0808X
NY635938163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse