Healthcare Provider Details

I. General information

NPI: 1235034406
Provider Name (Legal Business Name): WELLNESS FIRST NURSE PRACTITIONER IN PSYCHIATRIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 HAMILTON PL UNIT 2
HACKENSACK NJ
07601-3678
US

IV. Provider business mailing address

308 HAMILTON PL UNIT 2
HACKENSACK NJ
07601-3678
US

V. Phone/Fax

Practice location:
  • Phone: 518-331-2192
  • Fax: 551-403-9398
Mailing address:
  • Phone: 518-331-2192
  • Fax: 551-403-9398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GRACE ADEPOJU
Title or Position: PMHNP
Credential:
Phone: 518-331-2192