Adedamola Moji Adeboye, M.D

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

25MA10310300 Issued in NJ

Practice address

111 Northfield Ave Ste 311
West Orange, NJ 07052-4703

Phone

(973) 325-2103

NPI assigned

Mar 25, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Adedamola Moji Okunola Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• 3 Dimension Diagnostic Solutions

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  • NPI 1760704688
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1972997146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 NORTHFIELD AVE STE 311",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070524703",
            "telephone_number": "973-325-2103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 NORTHFIELD AVE STE 311",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070524703",
            "telephone_number": "973-325-2103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEBOYE",
        "first_name": "ADEDAMOLA",
        "middle_name": "MOJI",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-25",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "25MA10310300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ADEDAMOLA",
            "last_name": "OKUNOLA",
            "middle_name": "MOJI",
            "prefix": "DR.",
            "credential": "M.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bryant J Acquaro
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• Marta Acuna, LMFT
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• Adel Armanious MD PA
• Omotayo Adeniyi, PHD
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• Nephrology Physician in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Nephrology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.