Provider Demographics
NPI:1982381877
Name:CORNERSTONE NP IN PSYCHIATRY, PLLC
Entity Type:Organization
Organization Name:CORNERSTONE NP IN PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TOLULOPE
Authorized Official - Middle Name:OLAJUMOKE
Authorized Official - Last Name:KOLAWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, MHNP-BC, MSN
Authorized Official - Phone:718-200-5446
Mailing Address - Street 1:30 BELLE OAK LN
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2184
Mailing Address - Country:US
Mailing Address - Phone:973-687-4145
Mailing Address - Fax:
Practice Address - Street 1:115 S MACQUESTEN PKWY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1724
Practice Address - Country:US
Practice Address - Phone:718-200-5446
Practice Address - Fax:973-554-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0656623Medicaid