Healthcare Provider Details

I. General information

NPI: 1316499486
Provider Name (Legal Business Name): SILVESTER OLUOKUN L.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652-4142
US

IV. Provider business mailing address

27 HIGH ST APT 3L
ORANGE NJ
07050-1672
US

V. Phone/Fax

Practice location:
  • Phone: 201-262-4357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00334600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: