Provider Demographics
NPI:1396329587
Name:OYENIRAN, OYEFUNSO (PT)
Entity type:Individual
Prefix:
First Name:OYEFUNSO
Middle Name:
Last Name:OYENIRAN
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 1:8816 145TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3633
Mailing Address - Country:US
Mailing Address - Phone:304-710-7366
Mailing Address - Fax:
Practice Address - Street 1:2401 LACONIA AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-1406
Practice Address - Country:US
Practice Address - Phone:304-710-7366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist