Healthcare Provider Details

I. General information

NPI: 1689592628
Provider Name (Legal Business Name): CEDAR BLOOM WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 W CHESTNUT AVE STE 2
VINELAND NJ
08360-5550
US

IV. Provider business mailing address

971 US HIGHWAY 202 N STE N
BRANCHBURG NJ
08876-3757
US

V. Phone/Fax

Practice location:
  • Phone: 475-449-6183
  • Fax: 856-998-1204
Mailing address:
  • Phone: 475-449-6183
  • Fax: 856-998-1204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LYDIA OYAWOLE
Title or Position: CO-OWNER
Credential: APN
Phone: 856-398-0428