Provider Demographics
NPI:1023511037
Name:ENUYOKAN, ADESHOLA
Entity type:Individual
Prefix:MS
First Name:ADESHOLA
Middle Name:
Last Name:ENUYOKAN
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 1:71 VALLEY ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2825
Mailing Address - Country:US
Mailing Address - Phone:973-821-5841
Mailing Address - Fax:973-821-5845
Practice Address - Street 1:71 VALLEY ST STE 202
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2825
Practice Address - Country:US
Practice Address - Phone:973-821-5841
Practice Address - Fax:973-821-5845
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0586862Medicaid