Basic Information
Provider Information | |||||||||
NPI: | 1831346980 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AJAKAIYE | ||||||||
FirstName: | MICHAEL | ||||||||
MiddleName: | ADEBAYO | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | AJAKAIYE | ||||||||
OtherFirstName: | BAYO | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 509 N BROAD ST | ||||||||
Address2: |   | ||||||||
City: | WOODBURY | ||||||||
State: | NJ | ||||||||
PostalCode: | 080961617 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8568450100 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 509 N BROAD ST | ||||||||
Address2: |   | ||||||||
City: | WOODBURY | ||||||||
State: | NJ | ||||||||
PostalCode: | 080961617 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8568450100 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/20/2008 | ||||||||
LastUpdateDate: | 10/27/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/27/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 307483 | NY | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207Q00000X | A144911 | CA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 25MA10649200 | NJ | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207P00000X | 25MA10649200 | NJ | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
No ID Information.