Healthcare Provider Details

I. General information

NPI: 1689579658
Provider Name (Legal Business Name): OLUSEYI O OSANYINLUSI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1244 SPRINGFIELD AVE
IRVINGTON NJ
07111-1909
US

IV. Provider business mailing address

1244 SPRINGFIELD AVE
IRVINGTON NJ
07111-1909
US

V. Phone/Fax

Practice location:
  • Phone: 908-858-0700
  • Fax:
Mailing address:
  • Phone: 908-858-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number13VH10373800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: