Provider Demographics
NPI:1447670179
Name:AJIBADE, OLUWAKEMI OREOFE (MD)
Entity type:Individual
Prefix:
First Name:OLUWAKEMI
Middle Name:OREOFE
Last Name:AJIBADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2077
Mailing Address - Country:US
Mailing Address - Phone:973-709-0201
Mailing Address - Fax:
Practice Address - Street 1:759 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2077
Practice Address - Country:US
Practice Address - Phone:973-709-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10192000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine