Provider Demographics
NPI:1538136494
Name:ADESINA, ADEWALE T (PT)
Entity Type:Individual
Prefix:MR
First Name:ADEWALE
Middle Name:T
Last Name:ADESINA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5647
Mailing Address - Country:US
Mailing Address - Phone:908-791-9993
Mailing Address - Fax:908-979-9797
Practice Address - Street 1:25 CRAIG PL
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-4721
Practice Address - Country:US
Practice Address - Phone:908-791-9993
Practice Address - Fax:908-979-9797
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00661400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS77885Medicare UPIN
NJ026244Medicare ID - Type Unspecified