Provider Demographics
NPI:1396982856
Name:AKANDE, OLUBUSOLA MARILYNN
Entity type:Individual
Prefix:
First Name:OLUBUSOLA
Middle Name:MARILYNN
Last Name:AKANDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLUBUSOLA
Other - Middle Name:MARILYNN
Other - Last Name:SANYAOLU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:810 BOWER ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-2539
Mailing Address - Country:US
Mailing Address - Phone:212-939-4443
Mailing Address - Fax:212-939-4446
Practice Address - Street 1:810 BOWER ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-2539
Practice Address - Country:US
Practice Address - Phone:212-939-4443
Practice Address - Fax:212-939-4446
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005517-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant