Healthcare Provider Details

I. General information

NPI: 1003735028
Provider Name (Legal Business Name): TOLULOPE ODUNTAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 HANSBURY AVE
NEWARK NJ
07112-1965
US

IV. Provider business mailing address

153 HANSBURY AVE
NEWARK NJ
07112-1965
US

V. Phone/Fax

Practice location:
  • Phone: 929-637-9291
  • Fax:
Mailing address:
  • Phone: 929-634-9291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: