Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 25MA08476800 | NJ |
Y | 111NI0900X | Internist | 25MA08476800 | NJ |
N | 207RG0300X | Geriatric Medicine | 25MA08476800 | NJ |
NPI | 1013112069 |
---|---|
Provider Name | Dr. Olumuyiwa Adedotun Ibikunle |
First Address | Boston, MA 02241-6457 |
Second Address | Summit, NJ 07901-3533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 23/08/2017 |