Provider Demographics
NPI:1598866410
Name:BISHI, JUBRIL ADEYEMI (DPT)
Entity Type:Individual
Prefix:MR
First Name:JUBRIL
Middle Name:ADEYEMI
Last Name:BISHI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 GRAND CONCOURSE
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-8202
Mailing Address - Country:US
Mailing Address - Phone:718-579-3940
Mailing Address - Fax:718-518-5818
Practice Address - Street 1:1775 GRAND CONCOURSE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-8202
Practice Address - Country:US
Practice Address - Phone:718-579-3940
Practice Address - Fax:718-518-5818
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016546-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist