Provider Demographics
NPI:1194030338
Name:OLADIRAN-ADIGHIJE, SIMBIAT (PMHNP, PHD)
Entity Type:Individual
Prefix:DR
First Name:SIMBIAT
Middle Name:
Last Name:OLADIRAN-ADIGHIJE
Suffix:
Gender:F
Credentials:PMHNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 PENNSYLVANIA AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-1265
Mailing Address - Country:US
Mailing Address - Phone:973-444-5590
Mailing Address - Fax:
Practice Address - Street 1:614 PENNSYLVANIA AVENUE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201
Practice Address - Country:US
Practice Address - Phone:973-444-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00298600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health