Healthcare Provider Details

I. General information

NPI: 1043142987
Provider Name (Legal Business Name): BUKOLA A SALAMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1388 HARDING TER
HILLSIDE NJ
07205-1814
US

IV. Provider business mailing address

1388 HARDING TER
HILLSIDE NJ
07205-1814
US

V. Phone/Fax

Practice location:
  • Phone: 862-279-2613
  • Fax:
Mailing address:
  • Phone: 862-279-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NJ15583600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: