Provider Demographics
NPI:1871264846
Name:ADENIRAN-ADETOYE, IRETIOLUWA EMMANUELLA
Entity Type:Individual
Prefix:
First Name:IRETIOLUWA
Middle Name:EMMANUELLA
Last Name:ADENIRAN-ADETOYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WINDING WOOD DR APT 5A
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-2136
Mailing Address - Country:US
Mailing Address - Phone:718-844-1858
Mailing Address - Fax:
Practice Address - Street 1:2 WINDING WOOD DR APT 5A
Practice Address - Street 2:
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872-2136
Practice Address - Country:US
Practice Address - Phone:718-844-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY802601163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2997157Medicaid