Healthcare Provider Details

I. General information

NPI: 1003140666
Provider Name (Legal Business Name): ADEKUNLE OYESILE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E 7TH AVE
ROSELLE NJ
07203-2159
US

IV. Provider business mailing address

340 E 7TH AVE
ROSELLE NJ
07203-2159
US

V. Phone/Fax

Practice location:
  • Phone: 845-801-3451
  • Fax:
Mailing address:
  • Phone: 845-801-3451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOT023058
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS026164
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01329500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: