Individual provider Active NPI

Oluwaseun D Ajifowobaje

  • Physical Therapist
  • Astoria, NY
National Provider Identifier
1619492865
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
041656 Issued in NY
Practice address
3244 31St St
Astoria, NY 11106-2561
Phone
(718) 707-6970
Fax
(718) 707-6977
NPI assigned
Aug 9, 2017
Last updated
Apr 23, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Radiology Physician 2085N0904X 26845 MD
Diagnostic Radiology Physician 2085R0202X 26845 MD
Physical Therapist 225100000X 041656 NY Primary

Addresses

Primary practice location

3244 31St St
Astoria, NY 11106-2561

Mailing address

3244 31St St
Astoria, NY 11106-2561
Phone (718) 707-6970

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210201000067 MD Practitioner - Physical Therapist in Private Practice 7517226392 Reassigns benefits to 6 organizations
I20210416002010 DC Practitioner - Physical Therapist in Private Practice 7517226392 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3901 National Dr
Suite 100
Burtonsville, MD 20866-1176
Phone (301) 421-1125

515 Fairmount Ave
Suite 340
Towson, MD 21286-8522
Phone (443) 218-3379

7130 Minstrel Way
Ll110
Columbia, MD 21045-5261
Phone (240) 841-2639

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26845MDMDNuclear Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Integrate Diagnostics Physical Therapist CurrentSince May 1, 2025 Accepting new patients
Forever Fit Physical Therapy & Wellness LLC Physical Therapist CurrentSince Oct 3, 2023 Accepting new patients
Forever Fit Physical Therapy & Wellness, LLC CurrentSince Oct 3, 2023 Accepting new patients
Lifebridge Sports Medicine and Rehabilitation LLC Current Accepting new patients
Lifebridge Sports Medicine & Rehabilitation, LLC CurrentSince Sep 22, 2025 Accepting new patients
Lifebridge Sports Medicine and Rehabilitation LLC CurrentSince Sep 22, 2025 Accepting new patients
Medstar Health Physical Therapy at Home, LLC. Physical Therapist CurrentSince Apr 30, 2024 Accepting new patients
Shawn Dhillon, M.D., P.C. CurrentSince Nov 1, 2022 Accepting new patients
Medstar Health Physical Therapy at Home, LLC. Physical Therapist CurrentSince Apr 30, 2024 Accepting new patients
Shawn Dhillon, M.D., P.C. CurrentSince Nov 1, 2022 Accepting new patients

Locations

2 Hamill Rd
Ste 272
Baltimore, MD 21210
Phone (410) 261-8532

4000 Mitchellville Rd
Ste B222
Bowie, MD 20716
Phone (301) 421-1125

3901 National Dr
Ste 100
Burtonsville, MD 20866
Phone (301) 232-3684

10980 Grantchester Way
Columbia, MD 21044
Phone (410) 772-6500

7130 Minstrel Way
Ste LL110
Columbia, MD 21045
Phone (240) 841-2639

818 W Diamond Ave
Ste 110
Gaithersburg, MD 20878
Phone (301) 232-3684

10301 Georgia Ave
Ste 200
Silver Spring, MD 20902
Phone (301) 593-7300

515 Fairmount Ave
Ste 340
Towson, MD 21286
Phone (410) 296-5300

8600 La Salle Rd
Ste 322
Towson, MD 21286
Phone (410) 828-6778

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745366400000",
    "number": "1619492865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3244 31ST ST",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111062561",
            "telephone_number": "718-707-6970",
            "fax_number": "718-707-6977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3244 31ST ST",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111062561",
            "telephone_number": "718-707-6970",
            "fax_number": "718-707-6977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AJIFOWOBAJE",
        "first_name": "OLUWASEUN",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-09",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "MD",
            "license": "26845",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MD",
            "license": "26845",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "041656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Astoria, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.