Provider Demographics
NPI:1992205769
Name:ADEYIN, MICHAEL OSAS (MA, EDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:OSAS
Last Name:ADEYIN
Suffix:
Gender:M
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 QUABECK AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1007
Mailing Address - Country:US
Mailing Address - Phone:908-967-9690
Mailing Address - Fax:
Practice Address - Street 1:19 MILL RD
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1009
Practice Address - Country:US
Practice Address - Phone:908-967-9690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician