Provider Demographics
NPI:1972849560
Name:ADEYELE, DARE I (MD)
Entity Type:Individual
Prefix:
First Name:DARE
Middle Name:I
Last Name:ADEYELE
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 1:8647 164TH ST # 31
Mailing Address - Street 2:JAMAICA
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3450
Mailing Address - Country:US
Mailing Address - Phone:718-288-3332
Mailing Address - Fax:
Practice Address - Street 1:2015 GRAND CONCOURSE,
Practice Address - Street 2:ESSEN MEDICAL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-8648
Practice Address - Country:US
Practice Address - Phone:718-731-2020
Practice Address - Fax:718-294-6276
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 267278208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice