Healthcare Provider Details

I. General information

NPI: 1467272161
Provider Name (Legal Business Name): OJSO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WOODBINE AVE
STATEN ISLAND NY
10314-1834
US

IV. Provider business mailing address

150 WOODBINE AVE
STATEN ISLAND NY
10314-1834
US

V. Phone/Fax

Practice location:
  • Phone: 929-554-8850
  • Fax: 929-554-8860
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SARAH ONYENWE
Title or Position: OWNER
Credential: FNP
Phone: 929-554-8850