Provider Demographics
NPI:1649072398
Name:EVERPATH WELLNESS LLC
Entity type:Organization
Organization Name:EVERPATH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:ABIMBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTUFALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-778-0507
Mailing Address - Street 1:252A CAMDEN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2449
Mailing Address - Country:US
Mailing Address - Phone:347-778-0507
Mailing Address - Fax:
Practice Address - Street 1:2 UNIVERSITY PLZ
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6202
Practice Address - Country:US
Practice Address - Phone:347-778-0507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty