Provider Demographics
NPI:1710998778
Name:IDOWU, JOEL AKANDE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:AKANDE
Last Name:IDOWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4300
Mailing Address - Country:US
Mailing Address - Phone:718-273-6641
Mailing Address - Fax:718-273-6697
Practice Address - Street 1:1430 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4300
Practice Address - Country:US
Practice Address - Phone:718-273-6641
Practice Address - Fax:718-273-6697
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2080682084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01936727Medicaid
NYG86950Medicare UPIN
NY01936727Medicaid