Provider Demographics
NPI:1104069160
Name:OLUJIMI, VICTOR ADEOLA (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ADEOLA
Last Name:OLUJIMI
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 1:64 COMMERCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-4455
Mailing Address - Country:US
Mailing Address - Phone:631-369-5000
Mailing Address - Fax:
Practice Address - Street 1:64 COMMERCE DRIVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-4455
Practice Address - Country:US
Practice Address - Phone:631-369-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084928-01207X00000X
NY284928-01207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery