Healthcare Provider Details

I. General information

NPI: 1447090923
Provider Name (Legal Business Name): MOSES OBIDIKE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 04/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 BERGEN AVE
JERSEY CITY NJ
07306-4705
US

IV. Provider business mailing address

PO BOX 192
WASHINGTON NJ
07882-0192
US

V. Phone/Fax

Practice location:
  • Phone: 201-687-7167
  • Fax:
Mailing address:
  • Phone: 908-899-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15078600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: