Provider Demographics
NPI:1447286588
Name:POPOOLA, ADEOLA OLATUNJI (PT,MED)
Entity type:Individual
Prefix:MR
First Name:ADEOLA
Middle Name:OLATUNJI
Last Name:POPOOLA
Suffix:
Gender:M
Credentials:PT,MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1676 N OLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-3209
Mailing Address - Country:US
Mailing Address - Phone:732-367-0060
Mailing Address - Fax:732-367-0060
Practice Address - Street 1:399 ALBERT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5406
Practice Address - Country:US
Practice Address - Phone:732-367-0060
Practice Address - Fax:732-367-0060
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00832600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ025890UDSMedicare ID - Type UnspecifiedMEDICARE RENDERING NUMBER