Oluwabukola Princess Adasofunjo, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

25MA11118600 Issued in NJ

Practice address

87 Rte 17 N
Ste 118
Maywood, NJ 07607

Phone

(551) 996-4450

Fax

(551) 996-5729

NPI assigned

Apr 15, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Oluwabukola Princess Alo Former name

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: oadasofunjo327285@direct.ochin.org

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

• Children'S Specialized Hospital

  • Children's Rehabilitation Hospital
  • New Brunswick, NJ
  • NPI 1396886297

  Pediatrics

  Medicare reassignment NPD
• Rutgers Health - Behavioral Health

  • Psychiatry Physician
  • Cherry Hill, NJ
  • NPI 1891956298
  Medicare reassignment NPD
• Mirth Health Systems LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Princeton, NJ
  • NPI 1538885173
  NPD Authorized official
• Children' Specialized Hospital

  • Medically Fragile Infants and Children Day Care
  • Mountainside, NJ
  • NPI 1578604476
  NPD
• Rutgers Health - Behavioral Health

  • Psychiatry Physician
  • Piscataway, NJ
  • NPI 1144267337
  NPD

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

{
    "created_epoch": "1365984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672099200000",
    "number": "1114360666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FORT HEALTH",
            "address_2": "613 WASHINGTON BLVD",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "07310",
            "telephone_number": "201-208-2616",
            "fax_number": "973-250-4028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87 RTE 17 N",
            "address_2": "STE 118",
            "city": "MAYWOOD",
            "state": "NJ",
            "postal_code": "07607",
            "telephone_number": "551-996-4450",
            "fax_number": "551-996-5729"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "194 N Harrison St",
            "address_purpose": "LOCATION",
            "city": "Princeton",
            "state": "NJ",
            "postal_code": "085403516",
            "country_code": "US",
            "telephone_number": "609-445-3315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADASOFUNJO",
        "first_name": "OLUWABUKOLA",
        "middle_name": "PRINCESS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-15",
        "last_updated": "2022-12-27",
        "certification_date": "2022-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NJ",
            "license": "25MA11118600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OLUWABUKOLA",
            "last_name": "ALO",
            "middle_name": "PRINCESS",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Child & Adolescent Psychiatry Physician in Maywood, NJ
• Providers in Maywood, NJ by specialty
• Child & Adolescent Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.