Provider Demographics
NPI:1750844452
Name:OJE, OLAOLUWA OYESOJI (PTA)
Entity Type:Individual
Prefix:
First Name:OLAOLUWA
Middle Name:OYESOJI
Last Name:OJE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WINTHROP DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5739
Mailing Address - Country:US
Mailing Address - Phone:631-220-2591
Mailing Address - Fax:
Practice Address - Street 1:2 WINTHROP DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5739
Practice Address - Country:US
Practice Address - Phone:631-220-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY622096568208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY622096568OtherHPSO