Provider Demographics
NPI:1194109744
Name:IBITOKUN, HENRY ADEWOLE (APN-C)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:ADEWOLE
Last Name:IBITOKUN
Suffix:
Gender:
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 ROOSEVELT AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-2583
Mailing Address - Country:US
Mailing Address - Phone:908-279-5785
Mailing Address - Fax:
Practice Address - Street 1:88 ROOSEVELT AVE APT 105
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-2583
Practice Address - Country:US
Practice Address - Phone:908-279-5785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307386363LA2200X, 363LG0600X
NJ26NJ00578600363LA2200X, 363LF0000X, 363LG0600X, 363LP0808X
NYF348698-01363LF0000X
CT11683363LF0000X, 363LP0808X
NY404894363LP0808X
WAAP61303774363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology