MEDICARE: DR. ADEWALE SARAFADEEN ADENLOLA DPT DOCTOR OF PHYSIC

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	0186761	NY

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	HPN75755	OTHER	NY	CARE PLUS

General Provider Information

NPI Number	:	1336224773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADEWALE SARAFADEEN ADENLOLA DPT DOCTOR OF PHYSIC

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	:	718-363-2677

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	03/02/2026

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