Healthcare Provider Details

I. General information

NPI: 1336016625
Provider Name (Legal Business Name): JOHN EMMANUEL EJEH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5589
US

IV. Provider business mailing address

234 E 149TH ST
BRONX NY
10451-5589
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-6080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number052593-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: