Provider Demographics
NPI:1710551957
Name:ARIDEGBE, IFEOLUWA OMOTOLA (MD)
Entity type:Individual
Prefix:
First Name:IFEOLUWA
Middle Name:OMOTOLA
Last Name:ARIDEGBE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3527
Mailing Address - Country:US
Mailing Address - Phone:609-924-5510
Mailing Address - Fax:
Practice Address - Street 1:301 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3527
Practice Address - Country:US
Practice Address - Phone:609-924-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA12226300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program