DR. OLUBUKOLA T ADEYEYE (NPI# 1275930422) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275930422 |
| Entity Type | Individual |
| Full Name | DR. OLUBUKOLA T ADEYEYE |
| Other Name | DR. OLUBUKOLA T AJISAFE |
| Credential | M.D |
| Practice Address |
1801 Black River Blvd N Rome NY 13440-2427 |
| Practice Telephone | 3153373770 |
| Practice Fax Number | 3153375380 |
| Mailing Telephone | 3153373770 |
| Mailing Fax Number | 3153375380 |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2015-10-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 281482 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | LICENSE | 281482 | 01 |
| Street Address |
1801 BLACK RIVER BLVD N |
| City | ROME |
| State | NY |
| Zip Code | 13440-2427 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730151507 | Gibran Tallim | Family Medicine | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2006-02-06 |
| 1164083259 | Mona Lisa Smith | Nurse Practitioner | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2019-06-27 |
| 1174017297 | Diane P Clute | Nurse Practitioner | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2018-06-21 |
| 1245781467 | Patricia Jacqualine Zupan | Physician Assistant | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2016-10-24 |
| 1770816688 | Gulnara Rubinshteyn | Pediatrics | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2009-09-09 |
| 1659506111 | Desmond Francis | Internal Medicine | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2009-05-27 |
| 1093974511 | Reo Malachi Peniston | Family Medicine | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2008-06-09 |
| 1295890143 | Edwin A Vera | Nurse Practitioner | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2006-12-22 |
| 1932118684 | Adrienne Michelle Smith | Physician Assistant | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2006-08-05 |
| 1447280508 | M Shane Angleton | Physician Assistant | 1801 Black River Blvd N, Rome, NY 13440-2427 | 2006-07-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801409966 | Jamie Marcinkowski | Nurse Practitioner | 1617 N James Street, Suite 100, Rome, NY 13440 | 2020-08-28 |
| 1205452810 | Nichole Elizabeth Pollard | Optometrist | 1320 Floyd Ave, Suite 1, Rome, NY 13440 | 2020-06-19 |
| 1235750662 | Nicole Schrader | Social Worker | 7214 Bunal Blvd, Rome, NY 13440 | 2020-04-27 |
| 1457908212 | Darlene A. Sherman | Technician | 101 Glen Road S., Rome, NY 13440 | 2019-08-26 |
| 1841846847 | Delores A Smith | Technician | 7374 Davis Road, Rome, NY 13440 | 2019-08-15 |
| 1609342807 | Kent A Myers | Occupational Therapist | 200 West Dominic St, Rome, NY 13440 | 2018-10-16 |
| 1013376870 | Bonnie Flansburg | Physical Therapy Assistant | 101 W Liberty Street, Rome, NY 13440 | 2016-02-22 |
| 1760888689 | Ashley Elizabeth Bloomquist | Pharmacist | 808 West Chestnut Street, Rome, NY 13440 | 2014-11-05 |
| 1902231483 | Stephanie Ostalkiewicz | Licensed Practical Nurse | 701 Camp Street, Rome, NY 13440 | 2013-09-04 |
| 1992142251 | Tammy S. Guiliano | Registered Nurse | 401 Turin Street, The New York State School for The Deaf, Rome, NY 13440 | 2013-05-28 |
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| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134354798 | Erica Paez-zapata | Pediatrics | 18 Riverbend Dr Sw Ste 210, Rome, GA 30161-6019 | 2009-05-26 |
| 1629169834 | Pediatric & Adolescent Medical Assoc PC | Pediatrics | 117 W Liberty Street, Rome, NY 13440 | 2006-09-27 |
| 1124119318 | Laura M. Dovan | Pediatrics | 330 Turner Mccall Blvd., Suite 205, Rome, GA 30165 | 2006-09-27 |
| 1396848388 | Kinkee Chung | Pediatrics | 117 W. Liberty Street, Rome, NY 13440 | 2006-09-06 |
| 1407844624 | Elizabeth Anne Smith | Pediatrics | 402 N 4th Ave Sw, Rome, GA 30165-2812 | 2005-10-11 |
| 1730189416 | Lawrence Michael Glantz | Pediatrics | 117 W Liberty St, Rome, NY 13440-5758 | 2005-07-26 |
| 1477029759 | Imagine Pediatrics PC | Pediatrics | 18 Riverbend Dr Sw Ste 210, Rome, GA 30161-6019 | 2018-10-15 |
| 1982086880 | Kathryn Ford Carroll | Pediatrics | 85 John Maddox Drive Connector Nw, Rome, GA 30165-1233 | 2015-06-26 |
| 1750630349 | Richard Tyler Barnes | Pediatrics | 402 N 4th Ave Sw, Rome, GA 30165-2812 | 2012-08-29 |
| 1952677270 | Bridgette M Dingle | Pediatrics | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2012-03-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.