Provider Demographics
NPI:1598818569
Name:OLOJEDE, SAMSON KAYODE (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:SAMSON
Middle Name:KAYODE
Last Name:OLOJEDE
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:DR
Other - First Name:KAYODE
Other - Middle Name:SAMSON
Other - Last Name:OLOJEDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:251 HUNGRY HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2804
Mailing Address - Country:US
Mailing Address - Phone:516-668-8210
Mailing Address - Fax:516-569-4482
Practice Address - Street 1:23436 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1320
Practice Address - Country:US
Practice Address - Phone:718-949-9400
Practice Address - Fax:929-250-1700
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist