Healthcare Provider Details

I. General information

NPI: 1730030370
Provider Name (Legal Business Name): TEMILADE ASIMOLOWO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVE
BROOKLYN NY
11219-2916
US

IV. Provider business mailing address

9 PEBBLE BEACH WAY
WASHINGTON NJ
07882-1576
US

V. Phone/Fax

Practice location:
  • Phone: 862-703-1467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408150
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: