Provider Demographics
NPI:1245422872
Name:OLOKODANA, FEMI (MD ,PT)
Entity Type:Individual
Prefix:DR
First Name:FEMI
Middle Name:
Last Name:OLOKODANA
Suffix:
Gender:M
Credentials:MD ,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3303
Mailing Address - Country:US
Mailing Address - Phone:732-259-2954
Mailing Address - Fax:
Practice Address - Street 1:305 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1230
Practice Address - Country:US
Practice Address - Phone:570-909-9972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00503900225100000X
CT046146207Q00000X
NH13919207Q00000X
PAMD439103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist