Provider Demographics
NPI:1194103879
Name:OLADEJI, JACKLYN (NP-C)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:
Last Name:OLADEJI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JACKLYN
Other - Middle Name:
Other - Last Name:BILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1 PENN PLAZA
Mailing Address - Street 2:8TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10119
Mailing Address - Country:US
Mailing Address - Phone:201-341-3939
Mailing Address - Fax:888-807-0194
Practice Address - Street 1:1 PENN PLAZA
Practice Address - Street 2:8TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119
Practice Address - Country:US
Practice Address - Phone:201-341-3939
Practice Address - Fax:888-807-0194
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00555500363LA2200X, 363LG0600X, 363LP2300X
NY307252363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care