Provider Demographics
NPI:1417438698
Name:ABIODUN, DARE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DARE
Middle Name:
Last Name:ABIODUN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3178
Mailing Address - Country:US
Mailing Address - Phone:732-931-4699
Mailing Address - Fax:646-368-8339
Practice Address - Street 1:158 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3178
Practice Address - Country:US
Practice Address - Phone:732-931-4699
Practice Address - Fax:646-368-8339
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01810400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist