Provider Demographics
NPI:1558319483
Name:OKEYEMI, ADEBISI ABIODUN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MISS
First Name:ADEBISI
Middle Name:ABIODUN
Last Name:OKEYEMI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:528 ROCKAWAY AVE
Mailing Address - Street 2:1ST FLR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212
Mailing Address - Country:US
Mailing Address - Phone:718-207-3413
Mailing Address - Fax:718-493-2775
Practice Address - Street 1:528 ROCKAWAY AV
Practice Address - Street 2:2 FLR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5636
Practice Address - Country:US
Practice Address - Phone:718-207-3413
Practice Address - Fax:718-493-2775
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014897173000000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01987728Medicaid
NYQA022OtherMEDICARE NO
NY01987728Medicaid