Provider Demographics
NPI:1659962033
Name:OLUSANYA, OLAJUMOKE OYINDAMOLA (NP)
Entity Type:Individual
Prefix:MRS
First Name:OLAJUMOKE
Middle Name:OYINDAMOLA
Last Name:OLUSANYA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1833
Mailing Address - Country:US
Mailing Address - Phone:914-330-5629
Mailing Address - Fax:
Practice Address - Street 1:608 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1833
Practice Address - Country:US
Practice Address - Phone:914-330-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01075600363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care