Provider Demographics
NPI:1619017571
Name:SONGONUGA, SOFOLUWE O (PT)
Entity Type:Individual
Prefix:MR
First Name:SOFOLUWE
Middle Name:O
Last Name:SONGONUGA
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 1:525 PATRICIA CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2701
Mailing Address - Country:US
Mailing Address - Phone:201-407-7965
Mailing Address - Fax:973-313-9041
Practice Address - Street 1:525 PATRICIA CT
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2701
Practice Address - Country:US
Practice Address - Phone:201-407-7965
Practice Address - Fax:973-313-9041
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist