Provider Demographics
NPI:1477330397
Name:ODERINDE, OLUWOLE (APN)
Entity Type:Individual
Prefix:MR
First Name:OLUWOLE
Middle Name:
Last Name:ODERINDE
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 KOCH AVE
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-4400
Mailing Address - Country:US
Mailing Address - Phone:973-538-1800
Mailing Address - Fax:
Practice Address - Street 1:383 MILLER ST
Practice Address - Street 2:
Practice Address - City:VAUXHALL
Practice Address - State:NJ
Practice Address - Zip Code:07088-1314
Practice Address - Country:US
Practice Address - Phone:908-884-9815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR11869300163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health