Healthcare Provider Details

I. General information

NPI: 1902351711
Provider Name (Legal Business Name): JOHNSON BABAYEMI PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 ANDOVER AVE
PLAINFIELD NJ
07062-1305
US

IV. Provider business mailing address

33 ANDOVER AVE
PLAINFIELD NJ
07062-1305
US

V. Phone/Fax

Practice location:
  • Phone: 347-322-6776
  • Fax:
Mailing address:
  • Phone: 347-322-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00658200
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: