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General NPI Number Information
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NPI Number | 1649825944
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Entity Type | Organization
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Legal Business Name | GREEN OAK PROFESSIONAL HEALTH SERVICES
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 09/06/2019
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Provider Practice Location Address
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Address Line | 120 MILLBURN AVE STE 201
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City | MILLBURN
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State | NJ
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Zip | 07041-1935
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Country | US
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Telephone | 973-392-0217
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Fax |
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Provider Business Mailing Address
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Address Line | 735 S 12TH ST
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City | NEWARK
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State | NJ
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Zip | 07103-1740
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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
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Name | KAZEEM ALAO OLAJIDE
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Credential | APN-C
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Telephone | 973-392-0217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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