MEDICARE: ADEX PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6697193	OTHER	NY	GHI
3	75755	OTHER		CARE PLUS HEALTH PLAN

General Provider Information

NPI Number	:	1205825320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADEX PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	244 S KING ST
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-4233
Country	:	US
Telephone Number	:	516-805-1811
Fax Number	:	516-326-4393

Provider Business Practice Location Address
First Line	:	35 E 51ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-1305
Country	:	US
Telephone Number	:	718-363-2556
Fax Number	:	718-363-2677

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. ADEWALE SARAFADEEB ADENLOLA
Credential	:	PT BS MS
Telephone Number	:	516-805-1811

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	02/27/2026

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