Healthcare Provider Details

I. General information

NPI: 1639464001
Provider Name (Legal Business Name): PRESCILIA NWABIANI OGUNLEYE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PRESCILIA NWABIANI ISEDEH M.D.

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 08/23/2024
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 TREMONT AVENUE
EAST ORANGE NJ
07018
US

IV. Provider business mailing address

385 TREMONT AVENUE
EAST ORANGE NJ
07018
US

V. Phone/Fax

Practice location:
  • Phone: 973-676-1000
  • Fax:
Mailing address:
  • Phone: 973-676-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA10188600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: