MEDICARE: TEMILADE ASIMOLOWO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	408150	NY

General Provider Information

NPI Number	:	1730030370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEMILADE ASIMOLOWO

Provider Business Mailing Address
First Line	:	9 PEBBLE BEACH WAY
Second Line	:
City	:	WASHINGTON
State	:	NJ
Zip	:	07882-1576
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4802 10TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2916
Country	:	US
Telephone Number	:	862-703-1467
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/27/2026

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Directions to “ TEMILADE ASIMOLOWO ” Practice Location

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