Provider Demographics
NPI:1528833126
Name:ADEDEJI, OLUWASHOLA A
Entity type:Individual
Prefix:
First Name:OLUWASHOLA
Middle Name:A
Last Name:ADEDEJI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:OLUWASHOLA
Other - Middle Name:A
Other - Last Name:ADEDEJI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:125 WILDER ST FL 1
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-3034
Mailing Address - Country:US
Mailing Address - Phone:908-966-1752
Mailing Address - Fax:973-926-3862
Practice Address - Street 1:1215 LIBERTY AVE RM 115
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-2054
Practice Address - Country:US
Practice Address - Phone:908-966-1752
Practice Address - Fax:973-926-3862
Is Sole Proprietor?:No
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications