Provider Demographics
NPI:1033988399
Name:OMIDIRE, TOYIN BEATRICE
Entity Type:Individual
Prefix:MRS
First Name:TOYIN
Middle Name:BEATRICE
Last Name:OMIDIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TOYIN
Other - Middle Name:BEATRICE
Other - Last Name:OMIDIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:837 INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6558
Mailing Address - Country:US
Mailing Address - Phone:973-666-8433
Mailing Address - Fax:
Practice Address - Street 1:65 BERGEN ST # 1127
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-3001
Practice Address - Country:US
Practice Address - Phone:973-666-8433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16280200171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator