Provider Demographics
NPI:1770644270
Name:AKEJU, OLUWASANMI ABEL (PT)
Entity Type:Individual
Prefix:
First Name:OLUWASANMI
Middle Name:ABEL
Last Name:AKEJU
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 1:10 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-2302
Mailing Address - Country:US
Mailing Address - Phone:732-802-2022
Mailing Address - Fax:732-802-2022
Practice Address - Street 1:251 POWERS ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3028
Practice Address - Country:US
Practice Address - Phone:732-545-9191
Practice Address - Fax:732-545-0035
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00733000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086322Medicare ID - Type Unspecified