Olukunle Abiodun Fagbenro, DO

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

729 S 18TH Street
Newark, NJ 07103

Phone

(862) 220-9269

NPI assigned

Apr 17, 2024

Last updated

Apr 17, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

Practice roles

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.

• Cornerstone Care Services LLC

  dba Cornerstone Care Services

  • Respite Care
  • Newark, NJ
  • NPI 1396598918
  NPD

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

{
    "created_epoch": "1713312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1447004155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "729 S 18TH STREET",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "07103",
            "telephone_number": "862-220-9269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "729 S 18TH STREET",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "07103",
            "telephone_number": "862-220-9269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGBENRO",
        "first_name": "OLUKUNLE",
        "middle_name": "ABIODUN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-17",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith Ezike, MD
• Ndidiamaka Ezuma, APN
• Mark Alan Faber, MD
• Laura J. Facas-Sullivan, LSW
• Olumuyiwa Ishola Fadahunsi
• Laura Rachel Fagen, MD
• Yessenia Carolina Faican-Vizhnay
• Nykeisha Faison, MASSAGE THERAPIST
• Faithful Home Health Care Inc. (Faithful Inc.)
• Lynne Fakeye, M.D.

• Counselor in Newark, NJ
• Providers in Newark, NJ by specialty
• Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; 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.