Provider Demographics
NPI:1609474543
Name:OBOLANLE, OLAPEMI O
Entity Type:Individual
Prefix:
First Name:OLAPEMI
Middle Name:O
Last Name:OBOLANLE
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 1:68 GARSIDE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1006
Mailing Address - Country:US
Mailing Address - Phone:862-930-6688
Mailing Address - Fax:862-930-6689
Practice Address - Street 1:68 GARSIDE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1006
Practice Address - Country:US
Practice Address - Phone:862-930-6688
Practice Address - Fax:862-930-6689
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)