Provider Demographics
NPI:1023384971
Name:SALAKO, OLUWAKEMI EBUDOLA
Entity Type:Individual
Prefix:MRS
First Name:OLUWAKEMI
Middle Name:EBUDOLA
Last Name:SALAKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BREWSTER PL
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1107
Mailing Address - Country:US
Mailing Address - Phone:201-385-4158
Mailing Address - Fax:
Practice Address - Street 1:P10X
Practice Address - Street 2:2195 ANDREWS AVENUE NORTH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-563-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist