Provider Demographics
NPI:1851887921
Name:P&P PSYCHIATRIC AND RECOVERY CENTER LLC.
Entity Type:Organization
Organization Name:P&P PSYCHIATRIC AND RECOVERY CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADETULE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, APN
Authorized Official - Phone:862-297-3732
Mailing Address - Street 1:315 NOTTINGHAM WAY STE D5
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7932
Mailing Address - Country:US
Mailing Address - Phone:190-849-9537
Mailing Address - Fax:
Practice Address - Street 1:11 DUNDAR RD STE 105
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3513
Practice Address - Country:US
Practice Address - Phone:908-499-5375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00654800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00654800OtherLICENSE