Provider Demographics
NPI:1871653774
Name:AJAYI, OLALEYE A (PT)
Entity Type:Individual
Prefix:MR
First Name:OLALEYE
Middle Name:A
Last Name:AJAYI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 VOSE AVE
Mailing Address - Street 2:APT. B-9
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-1060
Mailing Address - Country:US
Mailing Address - Phone:973-674-1677
Mailing Address - Fax:973-674-6226
Practice Address - Street 1:765 VOSE AVE
Practice Address - Street 2:APT. B-9
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-1060
Practice Address - Country:US
Practice Address - Phone:973-674-1677
Practice Address - Fax:973-674-6226
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA00831500171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor