=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841149853
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLESSED HEALTHCARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2026
-----------------------------------------------------
Last Update Date | 01/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 615 S 19TH ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07103-1116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-964-4720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 615 S 19TH ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07103-1116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-964-4720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PPMHNP-BC
-----------------------------------------------------
Name | MATHIAS OMON OLOGBOSELE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-964-4720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------