MEDICARE: MR. JUBRIL ADEYEMI BISHI D.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	016546-1	NY

General Provider Information

NPI Number	:	1598866410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUBRIL ADEYEMI BISHI D.P.T

Provider Business Mailing Address
First Line	:	1775 GRAND CONCOURSE
Second Line	:	6TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10453-8202
Country	:	US
Telephone Number	:	718-579-3940
Fax Number	:	718-518-5818

Provider Business Practice Location Address
First Line	:	1775 GRAND CONCOURSE
Second Line	:	6TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10453-8202
Country	:	US
Telephone Number	:	718-579-3940
Fax Number	:	718-518-5818

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	09/17/2014

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