Provider Demographics
NPI:1144450222
Name:FADUGBA, OLUWATOYIN JOHN (PT)
Entity type:Individual
Prefix:
First Name:OLUWATOYIN
Middle Name:JOHN
Last Name:FADUGBA
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 1:2088 MURRAY HILL ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2129
Mailing Address - Country:US
Mailing Address - Phone:516-435-8726
Mailing Address - Fax:516-326-8225
Practice Address - Street 1:2088 MURRAY HILL ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2129
Practice Address - Country:US
Practice Address - Phone:516-435-8726
Practice Address - Fax:516-326-8225
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17495251E00000X, 261QP2000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No251E00000XAgenciesHome Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy