Provider Demographics
NPI:1568105450
Name:OLUWO, JOSEPH (RRT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:OLUWO
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1534
Mailing Address - Country:US
Mailing Address - Phone:862-202-0813
Mailing Address - Fax:
Practice Address - Street 1:430 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-1534
Practice Address - Country:US
Practice Address - Phone:862-202-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31D2257170305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service