Provider Demographics
NPI:1104523752
Name:OJO, ABOSEDE CECILIA (AGNP)
Entity type:Individual
Prefix:
First Name:ABOSEDE
Middle Name:CECILIA
Last Name:OJO
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08741-1522
Mailing Address - Country:US
Mailing Address - Phone:732-600-9670
Mailing Address - Fax:
Practice Address - Street 1:75 OLD TOMS RIVER RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7800
Practice Address - Country:US
Practice Address - Phone:732-451-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01414500363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology