Healthcare Provider Details

I. General information

NPI: 1376424283
Provider Name (Legal Business Name): THERESAH OWUSU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RIDGEDALE AVE STE 103
CEDAR KNOLLS NJ
07927-1106
US

IV. Provider business mailing address

14 RIDGEDALE AVE STE 103
CEDAR KNOLLS NJ
07927-1106
US

V. Phone/Fax

Practice location:
  • Phone: 973-295-6335
  • Fax:
Mailing address:
  • Phone: 973-295-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15433900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: