Individual
KOBE ADESANYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
188 MAIN ST, WOODBRIDGE, NJ 07095-1921
(917) 330-2481
Mailing address
188 MAIN ST, WOODBRIDGE, NJ 07095-1921
(917) 330-2481
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/01/2019
Last updated
05/01/2019
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