Provider Demographics
NPI:1780415760
Name:ADEWALE, ELIZABETH ADERONKE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ADERONKE
Last Name:ADEWALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11042 169TH ST # PRIVATE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-3469
Mailing Address - Country:US
Mailing Address - Phone:929-377-3416
Mailing Address - Fax:
Practice Address - Street 1:11042 169TH ST # PRIVATE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-3469
Practice Address - Country:US
Practice Address - Phone:929-377-3416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator