Provider Demographics
NPI:1346650835
Name:ADENIRAN, ADEBOYE ADEOYE
Entity type:Individual
Prefix:
First Name:ADEBOYE
Middle Name:ADEOYE
Last Name:ADENIRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SOMERSET ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-2948
Mailing Address - Country:US
Mailing Address - Phone:973-517-4679
Mailing Address - Fax:
Practice Address - Street 1:110 SOMERSET STREET
Practice Address - Street 2:APT 3A
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108
Practice Address - Country:US
Practice Address - Phone:973-517-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00279400225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant