Provider Demographics
NPI:1710566195
Name:OYENIRAN, OLUTIMILEHIN (MD)
Entity type:Individual
Prefix:DR
First Name:OLUTIMILEHIN
Middle Name:
Last Name:OYENIRAN
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 1:2565 HAMILTON TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4961
Mailing Address - Country:US
Mailing Address - Phone:908-344-8963
Mailing Address - Fax:
Practice Address - Street 1:130 E 67TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6136
Practice Address - Country:US
Practice Address - Phone:908-344-8963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330858207QS0010X
CT77510207QS0010X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine