Olufunmilayo Abimbola Adesanlu
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Woodbridge, NJ
NPI 1609388222 · NPPES record last updated Dec 19, 2024
Key facts
- NPI
- 1609388222
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 26NJ00775300 (NJ)
- Practice address
- 367 Berry St Ste 104
Woodbridge, NJ 07095-3341 - Phone
- (848) 309-5141
- NPI assigned
- Nov 5, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NJ, NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180920000021 | NJ | Practitioner - Nurse Practitioner | 0941551600 | Reassigns benefits to 1 organization |
| I20220204000938 | NY | Practitioner - Nurse Practitioner | 0941551600 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NJ00775300 | NJ | MD | Psychiatric/Mental Health Nurse Practitioner |
| 402321 | NY | MD | Psychiatric/Mental Health Nurse Practitioner |
| 1000108 | TX | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Openpalms Healthcare LLC | Current |
Accepting new patients | |
| Barnabas Health Medical Group, PC | Current |
Accepting new patients | |
| Genpsych, Inc | Past | Accepting new patients |
Locations
395 Grand St
Jersey City, NJ 07302
Phone (201) 915-2600
201 Lyons Ave
Newark, NJ 07112
Phone (732) 923-7455
266 King George Rd
Warren, NJ 07059
Phone (732) 667-7778
223 Monmouth Rd
West Long Branch, NJ 07764
Phone (732) 229-3838
367 Berry St
Ste 104
Woodbridge, NJ 07095
Phone (201) 802-8042
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 1000108 | TX | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 402321 | NY | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 26NJ00775300 | NJ | Yes |
Addresses
Primary practice location
367 Berry St Ste 104
Woodbridge, NJ 07095-3341
Mailing address
15 Rector Ave
Woodbridge, NJ 07095-3325
Phone (848) 309-5141
Other providers in Woodbridge, NJ
- Abc Collective
- Absolute Chiropractic & Massage, LLC
- Absolute Chiropractic Family Care of Woodbridge
- Absolute Eyewear
- Achieve Beyond
- Oluwatobi O Adesanlu
- Kobe Adesanya
- Advanced Allergy & Asthma Family Care LLC
- Aiman Afzal
- Courtney Agyeman
All providers in Woodbridge, NJ · Psychiatric/Mental Health Nurse Practitioner in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.