Individual provider · NPI-1

Oluwaseun D Ajifowobaje

Physical Therapist · Astoria, NY

NPI number1619492865
StatusActive
Last updated in NPPESApr 23, 2025

Details

NPI
1619492865
Entity type
Individual (NPI-1)
Name
Oluwaseun D Ajifowobaje
Sex
Male
Sole proprietor
No
Enumeration date
Aug 9, 2017
Certification date
Apr 23, 2025
Last updated
Apr 23, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225100000X Physical Therapist041656NYYes
2085N0904X 26845MD
2085R0202X Radiology, Diagnostic Radiology26845MD

Practice location

3244 31st St
Astoria, NY 11106-2561

Phone 718-707-6970 · Fax 718-707-6977

Mailing address

3244 31st St
Astoria, NY 11106-2561

Phone 718-707-6970 · Fax 718-707-6977

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