Provider Demographics
NPI:1407655970
Name:HENRY IBITOKUN LLC
Entity type:Organization
Organization Name:HENRY IBITOKUN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:ADEWOLE
Authorized Official - Last Name:IBITOKUN
Authorized Official - Suffix:
Authorized Official - Credentials:NP, APN
Authorized Official - Phone:315-610-6702
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:315-610-6702
Mailing Address - Fax:315-610-6703
Practice Address - Street 1:200 MIDDLESEX TPKE STE 210
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2033
Practice Address - Country:US
Practice Address - Phone:315-610-6703
Practice Address - Fax:315-610-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty