Healthcare Provider Details

I. General information

NPI: 1225672512
Provider Name (Legal Business Name): MONISOLA M SOMOYE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SOMERDALE RD STE 206
VOORHEES NJ
08043-1858
US

IV. Provider business mailing address

10 MORGAN HILL CT
BLACKWOOD NJ
08012-5308
US

V. Phone/Fax

Practice location:
  • Phone: 856-427-6245
  • Fax: 856-428-1639
Mailing address:
  • Phone: 856-266-4959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00952300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: