Provider Demographics
NPI:1356432678
Name:OGUNKOYA, ADENIYI (MD)
Entity type:Individual
Prefix:
First Name:ADENIYI
Middle Name:
Last Name:OGUNKOYA
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 1:964 SANFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111
Mailing Address - Country:US
Mailing Address - Phone:973-371-9050
Mailing Address - Fax:973-371-2593
Practice Address - Street 1:964 SANFORD AVENUE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111
Practice Address - Country:US
Practice Address - Phone:973-371-9050
Practice Address - Fax:973-371-2593
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41628207R00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0671207Medicaid
NJ0671207Medicaid
NJ06137920Medicare ID - Type Unspecified