Healthcare Provider Details

I. General information

NPI: 1568719102
Provider Name (Legal Business Name): JOEL OLADOSU PHYSICAL THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 E 85TH ST
BROOKLYN NY
11236-3803
US

IV. Provider business mailing address

955 E 85TH ST
BROOKLYN NY
11236-3803
US

V. Phone/Fax

Practice location:
  • Phone: 347-922-4222
  • Fax: 768-209-1536
Mailing address:
  • Phone: 347-922-4222
  • Fax: 768-209-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOEL OLADOSU
Title or Position: PRESIDENT
Credential:
Phone: 347-922-4222