Provider Demographics
NPI:1790148179
Name:JOBI-ODENEYE, SEGILADE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:SEGILADE
Middle Name:
Last Name:JOBI-ODENEYE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2168 MILLBURN AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2640
Mailing Address - Country:US
Mailing Address - Phone:973-444-0040
Mailing Address - Fax:973-843-7129
Practice Address - Street 1:2168 MILLBURN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2640
Practice Address - Country:US
Practice Address - Phone:973-444-0040
Practice Address - Fax:973-843-7129
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00182400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist