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General NPI Number Information
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NPI Number | 1447712781
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Entity Type | Individual
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Provider Name | OLANREWAJU FAMAKINWA APN
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Gender | Male
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Dates
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Enumeration Date | 04/04/2019
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 685 RIVER AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5288
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Country | US
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Telephone | 732-486-7373
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Fax | 732-282-7300
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Provider Business Mailing Address
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Address Line | 1101 WARREN ST
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City | ROSELLE
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State | NJ
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Zip | 07203-2735
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Country | US
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Telephone | 862-368-5399
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00888100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ00888100
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License Number State | NJ
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