Healthcare Provider Details

I. General information

NPI: 1093468209
Provider Name (Legal Business Name): FUNMILAYO A OGUNRUKU APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 ROUTE 22 STE 2
SPRINGFIELD NJ
07081-3109
US

IV. Provider business mailing address

50 CYPRESS ST APT 3
NEWARK NJ
07108-3750
US

V. Phone/Fax

Practice location:
  • Phone: 609-892-1358
  • Fax:
Mailing address:
  • Phone: 609-892-1358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01296300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: