Healthcare Provider Details

I. General information

NPI: 1992101729
Provider Name (Legal Business Name): BOSEDE JANET AKILO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 MORRIS AVE STE 101
UNION NJ
07083-7173
US

IV. Provider business mailing address

1519 GREGORY AVE
UNION NJ
07083-5567
US

V. Phone/Fax

Practice location:
  • Phone: 908-906-4522
  • Fax: 732-408-3908
Mailing address:
  • Phone: 908-906-4522
  • Fax: 732-408-3908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01065000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: