Omadesala Psychiatric Services, LLC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

OMADESALA PSYCHIATRIC SERVICES, LLC

Practice address

285 Durham Ave Ste 2a
Building 6
South Plainfield, NJ 07080-2546

Phone

(908) 548-8533

Fax

(908) 548-8532

NPI assigned

Jan 23, 2012

Organization subpart

No

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

Authorized official

Name

Mr. John D Vo

Title

Owner

Phone

(212) 365-0448

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1327276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327276800000",
    "number": "1386915387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "ROOSEVELT",
            "state": "NJ",
            "postal_code": "085550009",
            "telephone_number": "609-301-5089",
            "fax_number": "831-303-5089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 DURHAM AVE STE 2A",
            "address_2": "BUILDING 6",
            "city": "SOUTH PLAINFIELD",
            "state": "NJ",
            "postal_code": "070802546",
            "telephone_number": "908-548-8533",
            "fax_number": "908-548-8532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMADESALA PSYCHIATRIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-23",
        "last_updated": "2012-01-23",
        "status": "A",
        "authorized_official_last_name": "VO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-365-0448",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9760812",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Health Maintenance Organization in South Plainfield, NJ
• Providers in South Plainfield, NJ by specialty
• Health Maintenance Organization in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.