Modupeore Ajibade
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Union, NJ
NPI 1689425340 · NPPES record last updated May 7, 2024
Key facts
- NPI
- 1689425340
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 26NJ15019300 (NJ)
- Practice address
- 1945 Morris Ave Ste 7
Union, NJ 07083 - Phone
- (908) 291-2727
- NPI assigned
- Apr 1, 2024
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Bridgeway Behavioral Health Services
Practice addresses (Care Compare)
373 Clermont Ter
Union, NJ 07083-8073
Phone (908) 355-7886
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- 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 |
|---|---|---|---|---|
| I20251217004283 | NJ | Practitioner - Nurse Practitioner | 9739674789 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NJ15019300 | NJ | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jersey Behavioral Care LLC | Current |
Accepting new patients | |
| Bridgeway Behavioral Health Services | Current |
Accepting new patients | |
| Jersey Behavioral Care LLC | Past |
Accepting new patients |
Locations
152 Central Ave
Jersey City, NJ 07306
Phone (201) 370-4232
1945 Morris Ave
Ste 7
Union, NJ 07083
Phone (732) 685-7277
373 Clermont Ter
Union, NJ 07083
Phone (908) 355-7886
Interoperability endpoints
- ajibade.modupeore.p1@direct.nhscnj.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 26NJ15019300 | NJ | Yes |
Addresses
Primary practice location
1945 Morris Ave Ste 7
Union, NJ 07083
Mailing address
1945 Morris Ave Ste 7
Union, NJ 07083-3518
Phone (908) 291-2727
Other providers in Union, NJ
- Jasleen Ahuja
- Lateef Ajanaku-Makun
- Adebola Ajanaku
- Shiyanbola Ajao
- Juliet Ajayi
- Ajt Behavioral Therapy Inc
- Nneka Gloria Akaeme
- Tahira Akbar
- Bosede Janet Akilo
- Ifeoluwa Akindunbi
All providers in Union, 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 May 7, 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.