Provider Demographics
NPI:1356603260
Name:BURAIMOH, MORENIKEJI AYODELE (MD)
Entity type:Individual
Prefix:
First Name:MORENIKEJI
Middle Name:AYODELE
Last Name:BURAIMOH
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 1:195 STEELE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1050
Mailing Address - Country:US
Mailing Address - Phone:617-281-4340
Mailing Address - Fax:
Practice Address - Street 1:130 BIRDSEYE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2444
Practice Address - Country:US
Practice Address - Phone:860-247-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD85694207X00000X, 207XS0117X
CT69859207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine