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General NPI Number Information
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NPI Number | 1144450222
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Entity Type | Individual
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Provider Name | OLUWATOYIN JOHN FADUGBA PT
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Gender | Male
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 2088 MURRAY HILL ST
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City | ELMONT
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State | NY
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Zip | 11003-2129
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Country | US
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Telephone | 516-435-8726
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Fax | 516-326-8225
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Provider Business Mailing Address
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Address Line | 2088 MURRAY HILL ST
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City | ELMONT
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State | NY
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Zip | 11003-2129
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Country | US
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Telephone | 516-435-8726
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Fax | 516-326-8225
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 17495
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 17495
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 17495
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License Number State | NY
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