Provider Demographics
NPI:1740259639
Name:ADEOTI, ADEKUNLE (MD)
Entity type:Individual
Prefix:DR
First Name:ADEKUNLE
Middle Name:
Last Name:ADEOTI
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 1:277 COIT ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-4105
Mailing Address - Country:US
Mailing Address - Phone:973-676-1920
Mailing Address - Fax:973-373-0510
Practice Address - Street 1:277 COIT ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-4013
Practice Address - Country:US
Practice Address - Phone:973-676-1920
Practice Address - Fax:973-373-0510
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6381103Medicaid
NJ556098Medicare ID - Type Unspecified
NJ6381103Medicaid