Provider Demographics
NPI:1770708786
Name:IMAFIDON, EFOSA JULIUS (DPT)
Entity type:Individual
Prefix:
First Name:EFOSA
Middle Name:JULIUS
Last Name:IMAFIDON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 HUGUENOT ST APT 406
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6389
Mailing Address - Country:US
Mailing Address - Phone:917-834-7584
Mailing Address - Fax:
Practice Address - Street 1:4487 3RD AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-1526
Practice Address - Country:US
Practice Address - Phone:718-960-6173
Practice Address - Fax:718-960-9397
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist