Provider Demographics
NPI:1215701198
Name:AJEKIGBE, OMOLOLA RHODA
Entity type:Individual
Prefix:
First Name:OMOLOLA
Middle Name:RHODA
Last Name:AJEKIGBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OMOLOLA
Other - Middle Name:RHODA
Other - Last Name:OGUNSIJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 WINDFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4015
Mailing Address - Country:US
Mailing Address - Phone:407-419-4183
Mailing Address - Fax:
Practice Address - Street 1:1050 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1618
Practice Address - Country:US
Practice Address - Phone:516-374-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP125274207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine