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General NPI Number Information
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NPI Number | 1407655970
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Entity Type | Organization
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Legal Business Name | HENRY IBITOKUN LLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 200 MIDDLESEX TPKE STE 210
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City | ISELIN
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State | NJ
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Zip | 08830-2033
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Country | US
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Telephone | 315-610-6703
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Fax | 315-610-6703
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Provider Business Mailing Address
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Address Line | 88 ROOSEVELT AVE APT 105
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City | CARTERET
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State | NJ
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Zip | 07008-2583
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Country | US
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Telephone | 315-610-6702
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Fax | 315-610-6703
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | HENRY ADEWOLE IBITOKUN
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Credential | NP, APN
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Telephone | 315-610-6702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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