1912491770 NPI number — OLUWATOYIN AJAYI MEDICAL PRACTICE, PC

Table of content: DR. MARK ROBERT HEMPHILL MD (NPI 1609840537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912491770 NPI number — OLUWATOYIN AJAYI MEDICAL PRACTICE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLUWATOYIN AJAYI MEDICAL PRACTICE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1912491770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 FLATBUSH AVE STE C5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11225-3706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-336-1100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
546 EASTERN PKWY FL 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11225-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
--
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2018

Additional Information

Authorized Official

Authorized Official Last Name:
AJAYI
Authorized Official First Name:
OLUWATOYIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-336-1100

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  292657-1 , 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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