Healthcare Provider Details

I. General information

NPI: 1700453636
Provider Name (Legal Business Name): JULIE GBOGI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 PARK AVE
PLAINFIELD NJ
07060-3001
US

IV. Provider business mailing address

951 PARK AVE
PLAINFIELD NJ
07060-3001
US

V. Phone/Fax

Practice location:
  • Phone: 908-205-3790
  • Fax: 908-754-4450
Mailing address:
  • Phone: 905-205-3790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01146600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: