Provider Demographics
NPI:1790591451
Name:ADIGUN, RILWAN
Entity type:Individual
Prefix:
First Name:RILWAN
Middle Name:
Last Name:ADIGUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 LENOX AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3102
Mailing Address - Country:US
Mailing Address - Phone:917-495-9783
Mailing Address - Fax:
Practice Address - Street 1:99 LENOX AVE APT 1
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3102
Practice Address - Country:US
Practice Address - Phone:917-495-9783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities