Provider Demographics
NPI:1235760984
Name:OMIDIRE, FEMI RAMAT (APN)
Entity Type:Individual
Prefix:MR
First Name:FEMI
Middle Name:RAMAT
Last Name:OMIDIRE
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:973-393-2296
Mailing Address - Fax:862-849-2319
Practice Address - Street 1:40 UNION AVE STE 301
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3290
Practice Address - Country:US
Practice Address - Phone:973-393-2296
Practice Address - Fax:862-849-2319
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01012700363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health