Individual
MR. CHARLES AYOMIDE ADEDARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
5818 57TH DR FL 1, MASPETH, NY 11378-2231
(347) 659-2361
Mailing address
5818 57TH DR FL 1, MASPETH, NY 11378-2231
(347) 659-2361
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
039952
NY
Other
Enumeration date
03/17/2016
Last updated
03/17/2016
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