MEDICARE: OYEFUNSO OYENIRAN P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	045612	NY

General Provider Information

NPI Number	:	1396329587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OYEFUNSO OYENIRAN P.T.

Provider Business Mailing Address
First Line	:	8816 145TH ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11435-3633
Country	:	US
Telephone Number	:	304-710-7366
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 LACONIA AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-1406
Country	:	US
Telephone Number	:	304-710-7366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2021
Last Update Date	:	05/12/2021

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