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General NPI Number Information
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NPI Number | 1548133036
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Entity Type | Organization
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Legal Business Name | THE VINE HEALTH SERVICES LLC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 2710 VERONA AVE
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City | LINDEN
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State | NJ
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Zip | 07036-5121
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Country | US
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Telephone | 973-399-2848
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 VERONA AVE
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City | LINDEN
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State | NJ
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Zip | 07036-5121
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. ABIMBOLA V OLANREWAJU
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Credential | DNP, PMHNP, FNP
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Telephone | 973-432-9621
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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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