Healthcare Provider Details

I. General information

NPI: 1144013046
Provider Name (Legal Business Name): SAMUEL AKINBIYI OLABIYI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 YATES AVE
NEWARK NJ
07112-1638
US

IV. Provider business mailing address

38 YATES AVE
NEWARK NJ
07112-1638
US

V. Phone/Fax

Practice location:
  • Phone: 862-339-8779
  • Fax:
Mailing address:
  • Phone: 862-339-8779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number26NR25064000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number26NR2506440000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: