Provider Demographics
NPI:1346973948
Name:MAXICARE HEALTHCARE CONSULT
Entity Type:Organization
Organization Name:MAXICARE HEALTHCARE CONSULT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:OLUWATOSIN
Authorized Official - Middle Name:OMOTOYOSI
Authorized Official - Last Name:OLUNUGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-409-1406
Mailing Address - Street 1:151 ROUTE 10 E STE 101
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1452
Mailing Address - Country:US
Mailing Address - Phone:973-409-1406
Mailing Address - Fax:
Practice Address - Street 1:151 ROUTE 10 E STE 101
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1452
Practice Address - Country:US
Practice Address - Phone:973-409-1406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty