Healthcare Provider Details

I. General information

NPI: 1215621966
Provider Name (Legal Business Name): OLUWAPELUMI OLUWOLE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date: 01/08/2024
Reactivation Date: 10/16/2025

III. Provider practice location address

350 ENGLE STREET
ENGLEWOOD NJ
07631
US

IV. Provider business mailing address

128 WILLIAM STREET ENGLEWOOD, NEW JERSEY
ENGLEWOOD NJ
07631
US

V. Phone/Fax

Practice location:
  • Phone: 234-706-9697
  • Fax:
Mailing address:
  • Phone: 862-622-1938
  • Fax: 201-894-0839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: