Provider Demographics
NPI:1548736531
Name:CONSCIENTIAMD
Entity Type:Organization
Organization Name:CONSCIENTIAMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMBIAT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADIRAN-ADIGHIJE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-444-5590
Mailing Address - Street 1:650-652 NEWARK AVENUE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208
Mailing Address - Country:US
Mailing Address - Phone:973-444-5590
Mailing Address - Fax:917-477-6852
Practice Address - Street 1:650-652 NEWARK AVENUE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208
Practice Address - Country:US
Practice Address - Phone:973-444-5590
Practice Address - Fax:917-477-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty