Provider Demographics
NPI:1285621698
Name:ADEDEJI, ADEDAYO (MD)
Entity type:Individual
Prefix:DR
First Name:ADEDAYO
Middle Name:
Last Name:ADEDEJI
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 1:1408 RICHMOND ROAD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304
Mailing Address - Country:US
Mailing Address - Phone:718-979-5646
Mailing Address - Fax:718-979-5650
Practice Address - Street 1:1408 RICHMOND ROAD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304
Practice Address - Country:US
Practice Address - Phone:718-979-5646
Practice Address - Fax:718-979-5650
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212659207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02382878Medicaid
NYH12793Medicare UPIN
H12793Medicare UPIN