Provider Demographics
NPI:1407879836
Name:AMUSAN, OLADIPO OLATUNMBOSUN (DPT)
Entity Type:Individual
Prefix:
First Name:OLADIPO
Middle Name:OLATUNMBOSUN
Last Name:AMUSAN
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 1:381 PARK ST
Mailing Address - Street 2:STE 1C
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4320
Mailing Address - Country:US
Mailing Address - Phone:201-982-1687
Mailing Address - Fax:201-489-4772
Practice Address - Street 1:381 PARK ST
Practice Address - Street 2:STE 1C
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4320
Practice Address - Country:US
Practice Address - Phone:201-982-1687
Practice Address - Fax:201-489-4772
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00628700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ057737Medicare ID - Type UnspecifiedPHYSICAL THERAPY PART B