=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598917973
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OMOLAYO DARLENE RPA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2008
-----------------------------------------------------
Last Update Date | 12/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 DIAMOND HILL RD
-----------------------------------------------------
City | BERKELEY HEIGHTS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07922-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-783-4600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 DIAMOND HILL RD
-----------------------------------------------------
City | BERKELEY HEIGHTS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07922-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 25MP00892800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 0126841
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------