=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801599360
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MUJEEDAT OLAPEJU ADEYEMI DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2023
-----------------------------------------------------
Last Update Date | 03/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 OAK ST
-----------------------------------------------------
City | ELMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11003-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-424-2952
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 OAK ST
-----------------------------------------------------
City | ELMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11003-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-424-2952
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 050226
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------