Provider Demographics
NPI:1447658281
Name:OLUKAYODE A OLADEJI MD LLC
Entity type:Organization
Organization Name:OLUKAYODE A OLADEJI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUKAYODE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADEJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-238-8090
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-0696
Mailing Address - Country:US
Mailing Address - Phone:732-238-8090
Mailing Address - Fax:732-238-8091
Practice Address - Street 1:1 RACE TRACK RD
Practice Address - Street 2:SUITE A101
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3870
Practice Address - Country:US
Practice Address - Phone:732-238-8090
Practice Address - Fax:732-238-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06383900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ891991ZL2AOtherMEDICARE ID-TYPE UNSPECIFIED
NJ7067909Medicaid