Provider Demographics
NPI:1386410223
Name:ADESANLU, OLUWATOBI O (NP)
Entity type:Individual
Prefix:
First Name:OLUWATOBI
Middle Name:O
Last Name:ADESANLU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 BERRY ST
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3341
Mailing Address - Country:US
Mailing Address - Phone:973-200-8201
Mailing Address - Fax:
Practice Address - Street 1:367 BERRY ST
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3341
Practice Address - Country:US
Practice Address - Phone:973-979-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405619363LP0808X
FL11029858363LP0808X
NJ26NJ15012600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty