=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679271506
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADEDOYIN T KOLAWOLE APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2023
-----------------------------------------------------
Last Update Date | 08/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 517 ROUTE 1 S STE 5400
-----------------------------------------------------
City | ISELIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08830-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-447-9470
-----------------------------------------------------
Fax | 732-790-8133
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 155
-----------------------------------------------------
City | ISELIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08830-0155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-447-9470
-----------------------------------------------------
Fax | 732-790-8133
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ01473800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 26NR18320000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------