MEDICARE: OLAOLUWA OYESOJI OJE PTA

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	208100000X	Physical Medicine & Rehabilitation Physician	622096568	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	622096568	OTHER	NY	HPSO

General Provider Information

NPI Number	:	1750844452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLAOLUWA OYESOJI OJE PTA

Provider Business Mailing Address
First Line	:	2 WINTHROP DR
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5739
Country	:	US
Telephone Number	:	631-220-2591
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 WINTHROP DR
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5739
Country	:	US
Telephone Number	:	631-220-2591
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2019
Last Update Date	:	04/09/2019

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