Provider Demographics
NPI:1669406906
Name:ADEOLA R. UTHMAN. M.D.,P.C.
Entity type:Organization
Organization Name:ADEOLA R. UTHMAN. M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEOLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:UTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-282-3340
Mailing Address - Street 1:225 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1361
Mailing Address - Country:US
Mailing Address - Phone:718-282-3340
Mailing Address - Fax:718-469-4616
Practice Address - Street 1:225 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1361
Practice Address - Country:US
Practice Address - Phone:718-282-3340
Practice Address - Fax:718-469-4616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210407207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5P8451Medicare UPIN
G62305Medicare ID - Type Unspecified