Provider Demographics
NPI:1316391485
Name:AKINBAJO, OMODELE
Entity type:Individual
Prefix:
First Name:OMODELE
Middle Name:
Last Name:AKINBAJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CLIFTON PL APT G18
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-6191
Mailing Address - Country:US
Mailing Address - Phone:347-707-3541
Mailing Address - Fax:
Practice Address - Street 1:14933 259TH ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3026
Practice Address - Country:US
Practice Address - Phone:347-707-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308486164W00000X
NY761771-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse