MEDICARE: OLADIMEJI OKODUWA

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	038330	NY

General Provider Information

NPI Number	:	1932599966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLADIMEJI OKODUWA

Provider Business Mailing Address
First Line	:	1536 3RD AVE
Second Line	:	5TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10028-2167
Country	:	US
Telephone Number	:	212-861-2630
Fax Number	:	212-861-2685

Provider Business Practice Location Address
First Line	:	1536 3RD AVE
Second Line	:	5TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10028-2167
Country	:	US
Telephone Number	:	212-861-2630
Fax Number	:	212-861-2685

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

Provider Enumeration Date	:	01/29/2015
Last Update Date	:	01/29/2015

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Directions to “ OLADIMEJI OKODUWA ” Practice Location

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