Healthcare Provider Details

I. General information

NPI: 1942165634
Provider Name (Legal Business Name): KOLAWOLE O OKE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 ARCHIBALD LN
FLORENCE NJ
08518-4010
US

IV. Provider business mailing address

602 ARCHIBALD LN
FLORENCE NJ
08518-4010
US

V. Phone/Fax

Practice location:
  • Phone: 732-964-5872
  • Fax:
Mailing address:
  • Phone: 732-964-5872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number26NR21006700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: