Healthcare Provider Details

I. General information

NPI: 1558942300
Provider Name (Legal Business Name): OLUFEMI MARTINS APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E LAUREL RD STE 1700-A
STRATFORD NJ
08084-1354
US

IV. Provider business mailing address

42 E LAUREL RD STE 1700-A
STRATFORD NJ
08084-1354
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-7010
  • Fax: 856-566-6956
Mailing address:
  • Phone: 856-566-7010
  • Fax: 856-566-6956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01119400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: