Provider Demographics
NPI:1508910340
Name:OLOKUNGBEMI, ANTHONY AKINLOYE (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:AKINLOYE
Last Name:OLOKUNGBEMI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1031
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-7031
Mailing Address - Country:US
Mailing Address - Phone:718-324-8166
Mailing Address - Fax:718-324-7539
Practice Address - Street 1:4626 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1610
Practice Address - Country:US
Practice Address - Phone:718-324-8166
Practice Address - Fax:718-324-7539
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015375225100000X
DC2666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY223702012OtherFIRST HEALTH
NY660533OtherGHI PPO
NY121300POtherHIP
NY228870OtherWELLCARE
NY223702012OtherMPN
NYQP768OtherBLUE CROSS BLUE SHIELD
NY000000073981-BOtherGHI HMO
NY2292361OtherUNITED HEALTH CARE
NY6202200OtherCIGNA
NYP00288313OtherRAILROAD MEDICARE
NY01701817Medicaid
NY05714GOtherGHI MEDICARE
NY105663900OtherDEPT. OF LABOR
NY223702012OtherHORIZON
NYP-11231046OtherMULTIPLAN
NYPRISM NETWORKOther223702012-01
NY121300POtherHIP