Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MA41628 | NJ |
N | 111NI0900X | Internist | MA41628 | NJ |
Y | 207RA0201X | Internist - Allergy & Immunology | MA41628 | NJ |
NPI | 1356432678 |
---|---|
Provider Name | Adeniyi Ogunkoya |
First Address | Irvington, NJ 07111 |
Second Address | Irvington, NJ 07111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 06/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0671207 | (05) | NJ |
C57158 | (02) |