Provider Demographics
NPI:1275083305
Name:AMITY HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:AMITY HEALTHCARE SERVICES
Other - Org Name:AMITY HEALTHCARE SERVICES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUFUNMILAYO
Authorized Official - Middle Name:O
Authorized Official - Last Name:ILORI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP, APN-C
Authorized Official - Phone:973-580-1497
Mailing Address - Street 1:936 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6991
Mailing Address - Country:US
Mailing Address - Phone:908-557-9015
Mailing Address - Fax:908-686-6549
Practice Address - Street 1:936 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6991
Practice Address - Country:US
Practice Address - Phone:908-557-9015
Practice Address - Fax:908-686-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty