Healthcare Provider Details

I. General information

NPI: 1174863229
Provider Name (Legal Business Name): LINDA N OPPONG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 AVON AVE
NEWARK NJ
07108-1907
US

IV. Provider business mailing address

281 WINANS AVE
HILLSIDE NJ
07205-1448
US

V. Phone/Fax

Practice location:
  • Phone: 973-799-0880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00422900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ00422900
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00422900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: