Healthcare Provider Details

I. General information

NPI: 1912708439
Provider Name (Legal Business Name): MUIDEEN A IPADEOLA APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BOWMAN DR
VOORHEES NJ
08043-9612
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-355-7118
  • Fax: 856-325-5222
Mailing address:
  • Phone: 856-355-7118
  • Fax: 856-325-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15298300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: