Provider Demographics
NPI:1275076234
Name:BETIKU, ADEFEMI AYODEJI (DPT)
Entity type:Individual
Prefix:DR
First Name:ADEFEMI
Middle Name:AYODEJI
Last Name:BETIKU
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 1:30 EHRBAR AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3674
Mailing Address - Country:US
Mailing Address - Phone:201-788-6290
Mailing Address - Fax:
Practice Address - Street 1:30 EHRBAR AVE APT 403
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3674
Practice Address - Country:US
Practice Address - Phone:201-788-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01706100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist