Individual provider Active NPI

Olukemi Owoseni, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Jersey City, NJ
National Provider Identifier
1205136215
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
26NJ00719600 Issued in NJ
Practice address
196 Dwight St
Jersey City, NJ 07305-3204
Phone
(551) 258-4422
Fax
(551) 214-0210
NPI assigned
Oct 25, 2010
Last updated
Sep 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 26NJ00719600 NJ
Family Nurse Practitioner 363LF0000X SP023523 PA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 26NJ00719600 NJ Primary

Addresses

Primary practice location

196 Dwight St
Jersey City, NJ 07305-3204

Mailing address

192 Waverly Dr
East Stroudsburg, PA 18302-9061
Phone (347) 551-1187

Other identifiers 1

IdentifierTypeStateIssuer
0562521MedicaidNJ

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170614002590 NJ Practitioner - Nurse Practitioner 0446528491 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

Jersey City, NJ 07305
Phone (551) 258-4422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP023523PAMDFamily Nurse Practitioner
26NJ00719600NJMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Harmony & Unity Mental Health CurrentSince May 1, 2022 Accepting new patients
NJ Memory and Behavioral Care CurrentSince Feb 1, 2020 Accepting new patients

Locations

14 Ridgedale Ave
Ste 103
Cedar Knolls, NJ 07927
Phone (973) 295-6335

Organizations & group practices 2

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": "1287964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1205136215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "192 WAVERLY DR",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183029061",
            "telephone_number": "347-551-1187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 DWIGHT ST",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073053204",
            "telephone_number": "551-258-4422",
            "fax_number": "551-214-0210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWOSENI",
        "first_name": "OLUKEMI",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-25",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00719600",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP023523",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ00719600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0562521",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

Verify at the official NPI Registry.