Basic Information
Provider Information
NPI: 1003140666
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OYESILE
FirstName: ADEKUNLE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 19 PINGRY PL
Address2: APT A-15
City: ELIZABETH
State: NJ
PostalCode: 072083374
CountryCode: US
TelephoneNumber: 7189265219
FaxNumber:  
Practice Location
Address1: 609 MORRIS AVE
Address2:  
City: SPRINGFIELD
State: NJ
PostalCode: 070811511
CountryCode: US
TelephoneNumber: 9733797006
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/29/2009
LastUpdateDate: 09/29/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X40QA01329500NJY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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