Provider Demographics
NPI:1275076234
Name:BETIKU, ADEFEMI AYODEJI (DPT)
Entity Type:Individual
Prefix:DR
First Name:ADEFEMI
Middle Name:AYODEJI
Last Name:BETIKU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1020
Mailing Address - Country:US
Mailing Address - Phone:201-788-6290
Mailing Address - Fax:
Practice Address - Street 1:49 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1127
Practice Address - Country:US
Practice Address - Phone:973-248-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01706100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist