Provider Demographics
NPI:1912491770
Name:OLUWATOYIN AJAYI MEDICAL PRACTICE, PC
Entity Type:Organization
Organization Name:OLUWATOYIN AJAYI MEDICAL PRACTICE, PC
Other - Org Name:CITYBLOCK MEDICAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUWATOYIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-336-1100
Mailing Address - Street 1:495 FLATBUSH AVE STE C5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3706
Mailing Address - Country:US
Mailing Address - Phone:800-336-1100
Mailing Address - Fax:
Practice Address - Street 1:546 EASTERN PKWY FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1604
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292657-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty