Healthcare Provider Details

I. General information

NPI: 1528308913
Provider Name (Legal Business Name): MORIDIYAH ABIODUN ADEBULE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 UNION ST STE 37
ELIZABETH NJ
07202-2178
US

IV. Provider business mailing address

451 CLARKSON AVE
BROOKLYN NY
11203-2054
US

V. Phone/Fax

Practice location:
  • Phone: 347-500-7469
  • Fax:
Mailing address:
  • Phone: 718-245-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF408640-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: