Provider Demographics
NPI:1700053733
Name:AINA, ADENIYI OLUWADARE (PT)
Entity Type:Individual
Prefix:DR
First Name:ADENIYI
Middle Name:OLUWADARE
Last Name:AINA
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 1:33 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:PORT READING
Mailing Address - State:NJ
Mailing Address - Zip Code:07064-1406
Mailing Address - Country:US
Mailing Address - Phone:646-633-6470
Mailing Address - Fax:732-541-0604
Practice Address - Street 1:964 SANFORD AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1474
Practice Address - Country:US
Practice Address - Phone:646-633-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01256300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist