Provider Demographics
NPI:1346012614
Name:PRO PEACE NP IN PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:PRO PEACE NP IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADETULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-297-3732
Mailing Address - Street 1:11 DUNDAR RD STE 207
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:981 BAY ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4903
Practice Address - Country:US
Practice Address - Phone:862-297-3732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty