Provider Demographics
NPI:1609474543
Name:OBOLANLE, OLAPEMI O
Entity type:Individual
Prefix:
First Name:OLAPEMI
Middle Name:O
Last Name:OBOLANLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W MOUNT PLEASANT AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1620
Mailing Address - Country:US
Mailing Address - Phone:862-930-6688
Mailing Address - Fax:862-930-6689
Practice Address - Street 1:615 W MOUNT PLEASANT AVE STE 8
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1620
Practice Address - Country:US
Practice Address - Phone:862-930-6688
Practice Address - Fax:862-930-6689
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)