Provider Demographics
NPI:1124327309
Name:ADELEKE, OLUKOLA A (DPM)
Entity type:Individual
Prefix:DR
First Name:OLUKOLA
Middle Name:A
Last Name:ADELEKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 CISELEY DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5719
Mailing Address - Country:US
Mailing Address - Phone:651-747-7748
Mailing Address - Fax:856-783-2312
Practice Address - Street 1:20 BERLIN RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4546
Practice Address - Country:US
Practice Address - Phone:856-783-0039
Practice Address - Fax:856-783-2312
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00313500213EP1101X, 213ES0103X, 213ES0131X, 213E00000X
NY65P71601213ES0103X
PASC006259213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0315486Medicaid