Provider Demographics
NPI:1265756647
Name:ADEOSUN, OLUWADAMILARE
Entity type:Individual
Prefix:
First Name:OLUWADAMILARE
Middle Name:
Last Name:ADEOSUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 W 118TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1620
Mailing Address - Country:US
Mailing Address - Phone:212-932-6500
Mailing Address - Fax:
Practice Address - Street 1:264 W 118TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1620
Practice Address - Country:US
Practice Address - Phone:212-932-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2016-08-17
Deactivation Date:2012-10-31
Deactivation Code:
Reactivation Date:2013-09-04
Provider Licenses
StateLicense IDTaxonomies
NY619712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse