Healthcare Provider Details

I. General information

NPI: 1619740677
Provider Name (Legal Business Name): PATRICK AKINWUMI OLOWOPOROKU APN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 BROADWAY
RAHWAY NJ
07065-1924
US

IV. Provider business mailing address

1124 BROADWAY
RAHWAY NJ
07065-1924
US

V. Phone/Fax

Practice location:
  • Phone: 848-235-5934
  • Fax: 848-900-8008
Mailing address:
  • Phone: 917-873-2593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ14949800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: