Provider Demographics
NPI:1205825320
Name:ADEX PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ADEX PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEWALE
Authorized Official - Middle Name:SARAFADEEB
Authorized Official - Last Name:ADENLOLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT BS MS
Authorized Official - Phone:516-805-1811
Mailing Address - Street 1:244 S KING ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4233
Mailing Address - Country:US
Mailing Address - Phone:516-805-1811
Mailing Address - Fax:516-326-4393
Practice Address - Street 1:887 RUTLAND RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1911
Practice Address - Country:US
Practice Address - Phone:718-363-2556
Practice Address - Fax:718-363-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02622659Medicaid
NY6697193OtherGHI
75755OtherCARE PLUS HEALTH PLAN
75755OtherCARE PLUS HEALTH PLAN