Basic Information
| Provider Information | |||||||||
| NPI: | 1003140666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OYESILE | ||||||||
| FirstName: | ADEKUNLE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 PINGRY PL | ||||||||
| Address2: | APT A-15 | ||||||||
| City: | ELIZABETH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 072083374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189265219 | ||||||||
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| Practice Location | |||||||||
| Address1: | 609 MORRIS AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070811511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733797006 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2009 | ||||||||
| LastUpdateDate: | 09/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01329500 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.