Healthcare Provider Details

I. General information

NPI: 1083250484
Provider Name (Legal Business Name): OLASUMBO OLADERU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N OLDEN AVENUE EXT STE 11A
EWING NJ
08618-2100
US

IV. Provider business mailing address

4 BOLEYN CT
EWING NJ
08628-2231
US

V. Phone/Fax

Practice location:
  • Phone: 609-583-4969
  • Fax: 609-323-7285
Mailing address:
  • Phone: 609-321-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00987800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: