Provider Demographics
NPI:1215956339
Name:OJETAYO, DUROJAIYE SHADRACH (PT)
Entity type:Individual
Prefix:MR
First Name:DUROJAIYE
Middle Name:SHADRACH
Last Name:OJETAYO
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 1:787 N ASCAN ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4621
Mailing Address - Country:US
Mailing Address - Phone:516-561-3922
Mailing Address - Fax:516-561-3922
Practice Address - Street 1:19621 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2124
Practice Address - Country:US
Practice Address - Phone:718-776-3129
Practice Address - Fax:718-776-3224
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014849-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist