Provider Demographics
NPI:1306888789
Name:ODEJOBI, LOOKMAN K (MD)
Entity type:Individual
Prefix:DR
First Name:LOOKMAN
Middle Name:K
Last Name:ODEJOBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 CORLIES AVE
Mailing Address - Street 2:SUITE # 20
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6102
Mailing Address - Country:US
Mailing Address - Phone:732-776-9776
Mailing Address - Fax:732-776-9882
Practice Address - Street 1:2100 CORLIES AVE
Practice Address - Street 2:SUITE # 20
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6102
Practice Address - Country:US
Practice Address - Phone:732-776-9776
Practice Address - Fax:732-776-9882
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA 062733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7825901Medicaid
NJ7825901Medicaid
NJ796429Medicare PIN