Healthcare Provider Details

I. General information

NPI: 1578126751
Provider Name (Legal Business Name): ADETOKUNBO IBITOYE RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MADISON ST
NEW YORK NY
10002-7537
US

IV. Provider business mailing address

55 N ELLIOTT PL APT 4H
BROOKLYN NY
11205-1052
US

V. Phone/Fax

Practice location:
  • Phone: 646-634-7111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: