1831355940 NPI number — MR. THEOPHILUS ADEYINKA ADENIRAN LMSW

Table of content: MR. THEOPHILUS ADEYINKA ADENIRAN LMSW (NPI 1831355940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831355940 NPI number — MR. THEOPHILUS ADEYINKA ADENIRAN LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADENIRAN
Provider First Name:
THEOPHILUS
Provider Middle Name:
ADEYINKA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831355940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 CENTRE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11520-3106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-546-0031
Provider Business Mailing Address Fax Number:
917-848-4269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1931 MOTT AVE
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
FAR ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691-4103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-471-6818
Provider Business Practice Location Address Fax Number:
718-337-2750
Provider Enumeration Date:
07/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  065216 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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