Provider Demographics
NPI:1386843423
Name:POPPY PHYSICAL REHABILITATION CONSULTANTS
Entity Type:Organization
Organization Name:POPPY PHYSICAL REHABILITATION CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEOLA
Authorized Official - Middle Name:O
Authorized Official - Last Name:POPOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:732-804-7263
Mailing Address - Street 1:399 ALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5406
Mailing Address - Country:US
Mailing Address - Phone:732-367-0060
Mailing Address - Fax:
Practice Address - Street 1:399 ALBERT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5406
Practice Address - Country:US
Practice Address - Phone:732-367-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00832600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5628620001Medicare NSC
NJ092506Medicare PIN