Healthcare Provider Details

I. General information

NPI: 1831881267
Provider Name (Legal Business Name): BABAJIDE ADEBUSOYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1347 SYLVAN AVE
BRIDGEPORT CT
06606-2541
US

IV. Provider business mailing address

1347 SYLVAN AVE
BRIDGEPORT CT
06606-2541
US

V. Phone/Fax

Practice location:
  • Phone: 845-625-2816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: