Excelsior Grace LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

EXCELSIOR GRACE LLC

Practice address

959 W 4TH St
Plainfield, NJ 07063-1372

Phone

(347) 302-1212

NPI assigned

Nov 1, 2025

Last updated

Nov 4, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Oluwabunmi Omotayo, APNNPI 1124843792

Title

Owner

Phone

(347) 302-1212

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Oluwabunmi Omotayo

  • Psychiatric/Mental Health Nurse Practitioner
  • Chatham, NJ
  • NPI 1124843792
  Authorized official Same address or phone

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

{
    "created_epoch": "1761955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762214400000",
    "number": "1649149238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "959 W 4TH ST",
            "city": "PLAINFIELD",
            "state": "NJ",
            "postal_code": "070631372",
            "telephone_number": "347-302-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "959 W 4TH ST",
            "city": "PLAINFIELD",
            "state": "NJ",
            "postal_code": "070631372",
            "telephone_number": "347-302-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELSIOR GRACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-01",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A",
        "authorized_official_last_name": "OMOTAYO",
        "authorized_official_first_name": "OLUWABUNMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-302-1212",
        "authorized_official_credential": "APN"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Plainfield, NJ
• Providers in Plainfield, NJ by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; 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.