Provider Demographics
NPI:1821786146
Name:ASIMOLOWO, ADEDOYIN HEZEKIAH
Entity Type:Individual
Prefix:
First Name:ADEDOYIN
Middle Name:HEZEKIAH
Last Name:ASIMOLOWO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 LONG TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5406
Mailing Address - Country:US
Mailing Address - Phone:908-370-7546
Mailing Address - Fax:
Practice Address - Street 1:647 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1822
Practice Address - Country:US
Practice Address - Phone:908-370-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01468900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health