Provider Demographics
NPI:1336224773
Name:ADENLOLA, ADEWALE SARAFADEEN (DPT DOCTOR OF PHYSIC)
Entity Type:Individual
Prefix:DR
First Name:ADEWALE
Middle Name:SARAFADEEN
Last Name:ADENLOLA
Suffix:
Gender:M
Credentials:DPT DOCTOR OF PHYSIC
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Mailing Address - Street 1:244 SOUTH KING STREET
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4233
Mailing Address - Country:US
Mailing Address - Phone:516-805-1811
Mailing Address - Fax:718-363-2677
Practice Address - Street 1:887 RUTLAND RD
Practice Address - Street 2:ADEX PT PC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1911
Practice Address - Country:US
Practice Address - Phone:718-363-2556
Practice Address - Fax:718-363-2677
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0186761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02622659Medicaid
NYHPN75755OtherCARE PLUS
NYQ5WHA1QK6901Medicare ID - Type Unspecified