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General NPI Number Information
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NPI Number | 1033988399
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Entity Type | Individual
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Provider Name | MRS. TOYIN BEATRICE OMIDIRE
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Gender | Female
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Dates
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Enumeration Date | 12/28/2023
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 65 BERGEN ST # 1127
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City | NEWARK
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State | NJ
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Zip | 07107-3001
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Country | US
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Telephone | 973-666-8433
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Fax |
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Provider Business Mailing Address
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Address Line | 837 INWOOD RD
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City | UNION
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State | NJ
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Zip | 07083-6558
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Country | US
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Telephone | 973-666-8433
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 26NR16280200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15419900
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License Number State | NJ
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