Provider Demographics
NPI:1073086997
Name:GRACE NURSE PRACTITIONER IN PSYCHIATRIC MENTAL HEALTH.P.C
Entity Type:Organization
Organization Name:GRACE NURSE PRACTITIONER IN PSYCHIATRIC MENTAL HEALTH.P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NPP
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:ADEOLA
Authorized Official - Last Name:ADEPOJU
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:518-331-2192
Mailing Address - Street 1:308 HAMILTON PLACE HACKENSACK NEW JERSEY
Mailing Address - Street 2:UNIT 2
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:518-331-2192
Mailing Address - Fax:
Practice Address - Street 1:2742 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4036
Practice Address - Country:US
Practice Address - Phone:518-331-2192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty