Provider Demographics
NPI:1538059167
Name:IBIDAPO, ABIDEMI VICTORIA
Entity type:Individual
Prefix:
First Name:ABIDEMI
Middle Name:VICTORIA
Last Name:IBIDAPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 E COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-4732
Mailing Address - Country:US
Mailing Address - Phone:609-532-0614
Mailing Address - Fax:
Practice Address - Street 1:175 MADISON AVE FL 1
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2038
Practice Address - Country:US
Practice Address - Phone:609-914-6000
Practice Address - Fax:609-914-6182
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15350900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily