Healthcare Provider Details

I. General information

NPI: 1932076833
Provider Name (Legal Business Name): ABI WADA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NEWARK AVE STE 104
BELLEVILLE NJ
07109
US

IV. Provider business mailing address

1 ALACO LN
MILFORD NJ
08848-1905
US

V. Phone/Fax

Practice location:
  • Phone: 929-600-2398
  • Fax:
Mailing address:
  • Phone: 201-936-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15388300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: