Active NPI
Olutolase Ebunlomo
- Surgery Physician
- Matawan, NJ
National Provider Identifier
1730933383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- PTL19439
- Practice address
- 120 Matawan Ave
Matawan, NJ 07747-2640 - Phone
- (201) 282-9816
- NPI assigned
- Apr 11, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | PTL19439 | CA | Primary |
Addresses
Primary practice location
120 Matawan Ave
Matawan, NJ 07747-2640
Mailing address
120 Matawan Ave
Matawan, NJ 07747-2640
Phone (201) 282-9816
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251112001591 | CA | Order and Referring Only - General Surgery | 6204327869 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTL19439 | CA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759017600000",
"number": "1730933383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 MATAWAN AVE",
"city": "MATAWAN",
"state": "NJ",
"postal_code": "077472640",
"telephone_number": "201-282-9816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 MATAWAN AVE",
"city": "MATAWAN",
"state": "NJ",
"postal_code": "077472640",
"telephone_number": "201-282-9816"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBUNLOMO",
"first_name": "OLUTOLASE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-11",
"last_updated": "2025-09-28",
"certification_date": "2025-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "PTL19439",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Matawan, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.