Healthcare Provider Details

I. General information

NPI: 1629454533
Provider Name (Legal Business Name): KOLAWOLE ADEOTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SEYMOUR RD
HACKETTSTOWN NJ
07840-1004
US

IV. Provider business mailing address

220 SEYMOUR RD
HACKETTSTOWN NJ
07840-1004
US

V. Phone/Fax

Practice location:
  • Phone: 973-517-1980
  • Fax:
Mailing address:
  • Phone: 973-517-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00532000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: