Provider Demographics
NPI:1881027522
Name:DR. OLUYEMI O BADERO, PHYSICIAN, P.C.
Entity Type:Organization
Organization Name:DR. OLUYEMI O BADERO, PHYSICIAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUYEMI
Authorized Official - Middle Name:O
Authorized Official - Last Name:BADERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-209-8000
Mailing Address - Street 1:10819 FLATLANDS 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4644
Mailing Address - Country:US
Mailing Address - Phone:718-209-8000
Mailing Address - Fax:718-444-2887
Practice Address - Street 1:1932 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5506
Practice Address - Country:US
Practice Address - Phone:718-209-8000
Practice Address - Fax:718-444-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190052207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty