Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01329500 | NJ |
NPI | 1003140666 |
---|---|
Provider Name | Adekunle Oyesile |
First Address | Elizabeth, NJ 07208-3374 |
Second Address | Springfield, NJ 07081-1511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2009 |
Last Update Date | 29/09/2009 |